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Comment by getpost | Hacker News Reader

Scripps cardiologist Eric Topol (not commenting on this article): "That's wrong. The CAC is anything but definitive. Many patients are told they have significant coronary artery disease by calcium score and it turns out, by CT angiography or cardiac catheterization, they have normal arteries. No less anxiety (often chronic and severe) and unnecessary procedures that are induced by false positive CACs." https://x.com/EricTopol/status/2092682606815117763

Coronary calcium scans quantify calcified atherosclerotic plaque but cannot reliably distinguish stable plaques from rupture-prone plaques or detect noncalcified plaques, some of which may be particularly vulnerable.

https://www.ahajournals.org/doi/pdf/10.1161/JAHA.118.008564

https://www.jacc.org/doi/10.1016/j.jcmg.2017.03.005

https://www.atherosclerosis-journal.com/article/S0021-9150(1...

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Eric Topol has some opinions. Some other cardiologists disagree. There probably is value in CAC for at least a subset of patients.

In the messy real world of medicine there are hardly any definitive screening tests or imaging studies. Everything will have some false positives and false negatives, or even if the output is physiologically accurate it may not be practically useful in improving patient outcomes. For screening tests we also have to weigh the costs versus benefits in terms of the number of procedures performed or dollars spent to save a life; if the numbers are too high then those scarce resources should be expended on other healthcare services.

For broad screening coverage by most health plans the key next step is an evaluation by the U.S. Preventive Services Task Force. This process is already underway but it takes a while for them to evaluate all the evidence and make a decision. For Medicare coverage there is a separate coverage determination process.

https://www.uspreventiveservicestaskforce.org/uspstf/

https://www.cms.gov/medicare/coverage/determination-process

On a similar personal note, I had a half-year health scare that ended just today.

In May, they told me on ultrasound that my dilated aortic root has grown by more than 2 mm in the last year and that if the progression does not stop, an operation will sooner or later be necessary.

I got a referral to magnetic resonance and had to wait for it until October. Was there last week, nervous. Today I got the result: compared to the MR from 2021, there is no progression at all. The same 44 mm as then. The ultrasound was just not as precisely done, or the doctor measured it slightly askew or what.

Ooof.

Sorry to inject whatever uncertainty this produces, but how do you know that the most recent "no growth" reading is the correct one? To me your story justifies at least 1 or 2 more regular scans.

I was told by the cardiologist who ordered both scans that MR results are very precise, while ultrasound is more of an "orientation scan" and small variations in how the doctor holds the probe and interprets the picture can add up to milimeters of difference. If there is a discrepancy, MR is the gold standard for decisions about treatment.

This was at IKEM in Prague, one of the best cardio units around, so I trust their judgment.

https://www.ikem.cz/en/

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