An inside look at heart health: How advanced cardiac imaging is changing the game

Have you ever wondered how doctors can see inside your heart without opening you up ? 

They use technology called "noninvasive cardiovascular imaging." This means doctors take pictures of your heart with sophisticated machines, without the need to open your chest with an incision. 

These tools offer safer, faster and more accurate testing for heart conditions. That in turn can lead to better, more effective treatment. They're usually available only in big cities and teaching hospitals, though. 

Why? Because the technology is often used in research. It's also because doctors need years of extra training to use the tools, says PeaceHealth cardiologist Kevin Steel, DO.

Dr. Steel is an expert in heart imaging and the director of cardiac MRI at PeaceHealth in Bellingham, Washington. He's working with Dr. Jason Stoane, a neuroradiologist from Mt. Baker Imaging, to offer these tools in northwest Washington.

“We really have something unique going on,” Dr. Steel says.   Instead of heading to a city like Seattle, people in the Bellingham area can ask their provider for a referral to PeaceHealth or Mt. Baker Imaging.

When are these tests done and for what conditions? 

There’s a lot to understand about advances in heart imaging technology. Here, Dr. Steel explains the basics:

Coronary computed tomography angiography: CCTA uses X-rays and 3D technology to check if there are blockages in your coronary arteries. It's usually done for people between 30 and 70 years old, and it works best when the heart beats slowly to get clear pictures. 

AI-assisted fractional flow reserve computed tomography: A CT scan takes a detailed look at your heart's arteries. It's used to figure out if there are blockages. 

Traditionally, doctors would have to put a long, thin tube called a catheter inside your body to get pictures.    But CT scans are noninvasive, so there’s no need for equipment like a catheter. They use a contrasting dye to spot blocked arteries. The AI part of the technology used by Drs. Steel and Stoane can do a detailed analysis. This is especially helpful when there's a lot of calcium buildup in the arteries. 

The AI makes the scan more accurate because it can measure how fast or slow the contrast dye moves through the artery. It can then flag possible blockages for your doctor to review. It gives them more information to decide if you would benefit from stents to keep your arteries open.

Cardiac MRI: An MRI of the heart can be done for many reasons. It uses a system of magnets and special cameras to gather images. This test can spot things like scar tissue, fluid and inflammation, which are hard to see any other way.

 “You get not just pictures of the heart, like a CAT scan, but also the motion of the heart and an evaluation of the heart muscle itself,” Dr. Steel says of the technology. It’s essentially making a movie of the heart and the valves and how they work.

A cardiac MRI can check for signs of heart failure, issues with heart valves, lumps or tumors in the heart, heart inflammation (myocarditis) and heart concerns after getting COVID. It can also help doctors learn more about why you have symptoms like chest pain, shortness of breath or fainting.

One benefit of this type of test is that it’s quick and easy. It can take as little as 30 minutes, or last up to an hour and a half. There’s no need for catheters to be inserted in a vein or for a stay in the hospital to have a scan done.

Cardiac stress MRI: Stress tests look at how your heart works while you make it beat harder with exercise. Often a small amount of radioactive dye — called a tracer — is injected in your vein to help the doctor do the test. 

Using an MRI avoids the need for radiation. It can show how well the blood vessels around the heart (coronary arteries) are working. Doctors use it to figure out if these arteries are blocked or if bypass surgeries are working well. It can also show if you need stents or bypass surgery to improve heart function. It’s a good choice for women and/or when someone’s weight is a concern.

Most imaging centers that do MRI-based stress tests are attached to a hospital. Mt. Baker Imaging is among the first free-standing centers  in the U.S. to offer it. 

In-demand technology

The collaboration between PeaceHealth and Mt. Baker means that patients in the area have access to new technology sooner than if each group had built capacity for it on its own. And since the procedures are noninvasive, you don’t have to plan for a hospital stay to get advanced scans.

Sometimes Dr. Steel’s team can bring the new technology where it’s needed, too. PeaceHealth recently performed the first cardiac MRI in the Puget Sound’s San Juan Islands. They us ed a mobile MRI scanner with a patient at PeaceHealth Peace Island Medical Center in Friday Harbor.

Since they’ve added the new technology, Drs. Steel and Stoane are seeing people not just from Bellingham or surrounding areas in Whatcom County, which they expected. They’re also getting patients referred from doctors in Canada and Seattle.   Typically, a heart imaging team might do about 200 of these MRIs a year. But the PeaceHealth-Mt. Baker team is on track to care for 1,500 patients in its first year.

“We worked hard to create a safe, welcoming environment,” Dr. Stoane says, and their collaboration makes it easier than ever to get quality heart care close to home.