Will a Cleerly guided paradigm which incorporates newer treatments replace our current ineffective approach and become the key to eliminating heart attack, stroke and other manifestations of ASCVD
My CAC score is 1923 reported on my recent Cleerly exam and it worked out well. It was on a fast scanner with equivalent of 560 slices and a prep of a beta blocker to ensure a slow heart rate.
My husband had a CTA scan with contrast and came great. He is 75 and has a high calcium score (>1,000). The nurse told him to continue doing what he is doing as he has a 85% flow in his arteries
I think this is a great tool to try and identify people who are at great risk of a coronary event; but I think it would be even more useful to try and identify causes of plaque rupture. Also, how well does plaque burden correlate with plaque rupture?
Eliminating cardiovascular risk cannot be used by itself to guide therapy. For example, in elderly patients eliminating cardiovascular risk may be associated with shortened life span. Also in younger patients a high calcium score is not associated with high cardiovascular risk if patients are heavy exercisers.
Also, these days it is almost impossible to get good clinical care from cardiologists due to the high patient loads needing to see them. So factoring all the issues relevant to the individual patient means that cardiologists these days let nurses care for them. I. am reminded of the ads on TV selling the latest toxic chemo therapy and instructing the patient to call their doctor if they develop ( one of a hundred) life threatening complications, only. to discover that the doctor can't see you for 6 months and. you can call the on call nurse for "help". Good luck with that. The practice of medical research publishing only relative risk results rather than absolute risk. in the abstract also is deceptive, hiding clinically signifcant outcomes.
Primary outcome is composite of CV death, MI, stroke (all good), but also Acute limb ischemia (ok)…..and revasc and urgent HF visits. The last 2 are not great for an open label study….when people will be walking around after being told “you have blockages/hardening”….hence more likely to react to minor symptoms…and thus more likely to present for more urgent care which in the US results in more interventions….the evidence notwithstanding.
Yes, Cleerly is a process which is dependent on the quality of the initial CCTA. Centers that are using optimal technique and the latest scanners do a better job of imaging when calcium deposition is high and dense. I've used it in a few patients with levels around 1000 but not in the >2000 range
My CAC score is 1923 reported on my recent Cleerly exam and it worked out well. It was on a fast scanner with equivalent of 560 slices and a prep of a beta blocker to ensure a slow heart rate.
My CAC score is 1923 reported on my recent Cleerly exam and it worked out well. It was on a fast scanner with equivalent of 560 slices and a prep of a beta blocker to ensure a slow heart rate.
My husband had a CTA scan with contrast and came great. He is 75 and has a high calcium score (>1,000). The nurse told him to continue doing what he is doing as he has a 85% flow in his arteries
William Reichert
So right about RRR v ARR:
https://pmc.ncbi.nlm.nih.gov/articles/PMC10153768/
NB that "side effects" (bad effects) are cited in absolute terms while "benefits" are cited in relative terms
Disingenuous.
I think this is a great tool to try and identify people who are at great risk of a coronary event; but I think it would be even more useful to try and identify causes of plaque rupture. Also, how well does plaque burden correlate with plaque rupture?
Eliminating cardiovascular risk cannot be used by itself to guide therapy. For example, in elderly patients eliminating cardiovascular risk may be associated with shortened life span. Also in younger patients a high calcium score is not associated with high cardiovascular risk if patients are heavy exercisers.
Also, these days it is almost impossible to get good clinical care from cardiologists due to the high patient loads needing to see them. So factoring all the issues relevant to the individual patient means that cardiologists these days let nurses care for them. I. am reminded of the ads on TV selling the latest toxic chemo therapy and instructing the patient to call their doctor if they develop ( one of a hundred) life threatening complications, only. to discover that the doctor can't see you for 6 months and. you can call the on call nurse for "help". Good luck with that. The practice of medical research publishing only relative risk results rather than absolute risk. in the abstract also is deceptive, hiding clinically signifcant outcomes.
Medicare won't pay for this type of screening either.
Too complicated for me to understand.
Primary outcome is composite of CV death, MI, stroke (all good), but also Acute limb ischemia (ok)…..and revasc and urgent HF visits. The last 2 are not great for an open label study….when people will be walking around after being told “you have blockages/hardening”….hence more likely to react to minor symptoms…and thus more likely to present for more urgent care which in the US results in more interventions….the evidence notwithstanding.
My CAC is 2536. I understand CTA isn’t effective for CAC >1000. I believe Cleerly uses CTA data. Can Cleerly work for CAC >1000?
Yes, Cleerly is a process which is dependent on the quality of the initial CCTA. Centers that are using optimal technique and the latest scanners do a better job of imaging when calcium deposition is high and dense. I've used it in a few patients with levels around 1000 but not in the >2000 range
My CAC score is 1923 reported on my recent Cleerly exam and it worked out well. It was on a fast scanner with equivalent of 560 slices and a prep of a beta blocker to ensure a slow heart rate.