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Examine the heart - by catheter, CT or MRI?

As of: 09/28/2020 12:25 p.m.
If you have heart problems, an examination is important to clarify the causes.

More than 800,000 cardiac catheter examinations are carried out in Germany every year. In more than half of the cases it turns out that there is no narrowing of the coronary arteries - this could be treated with a catheter. In other cases, the procedure could be replaced by an imaging procedure such as computed tomography of the heart (cardio-CT) - especially in younger patients without risk factors with atypical symptoms, which usually have causes other than a heart attack.

VIDEO: Examine the heart - by catheter, CT or MRI? (6 min)

Cardiac catheters: surgery with risks

The cardiac catheter examination is a minimally invasive operation with risks. In order to route the catheter from the wrist or groin to the heart, an artery must be punctured. This can lead to secondary bleeding, vascular and nerve irritation, bruising and, in extremely rare cases, to fatal complications. Therefore, the patients must be observed in the clinic for a certain period of time after the examination.

When the heart catheter makes sense

The cardiac catheter is indispensable when narrowed or blocked coronary arteries have to be dilated or cardiac arrhythmias have to be treated. Even with typical symptoms of a heart attack - such as chest pain radiating to the shoulder, arm, back or jaw - and accompanying shortness of breath, an immediate cardiac catheter examination is the method of choice.

Before a diagnostic catheter examination, tests such as an exercise ECG and an ultrasound examination, the so-called heart echo, help to assess the likelihood of a narrowing in a coronary vessel. In echocardiography (heart echo), doctors see the structure of the heart, can estimate the size of the heart chambers and the heart muscle and measure the function of the heart valves and the pumping capacity of the heart. An immediate cardiac catheter examination is only advisable if there are indications of a bottleneck. In order to rule out a bottleneck with a low or medium probability, the less stressful examination in the computer tomograph (CT) is also suitable.

Benefits of cardiac CT

Computed tomography can be performed on an outpatient basis. The examination usually takes five to ten minutes. The display options and the speed of CT devices have made enormous progress in recent years. In some respects they are even superior to catheter examinations. At the same time, the radiation exposure fell dramatically: With the latest devices, it is only about a hundredth of the previously usual dose and is therefore comparable to the radiation exposure of a catheter examination carried out under fluoroscopic fluoroscopy. The amount of contrast agent that is harmful to the kidneys is also comparable for both methods.

When a cardio CT makes sense

The ideal procedure is cardiac CT to examine the coronary veins prior to implanting pacemakers and aortic valves. The examination can also be used to determine calcium deposits in the coronary arteries (calcium score). As a result, cardiac CT allows a more precise assessment of the risk of heart attack in some patients.

Cardio-CT also possible under stress

Cardio-CT provides high-resolution images of the heart, which are displayed in slices and also in three dimensions and in motion. With the use of certain drugs, the heart can also be examined under stress. As with the stress ECG, circulatory disorders come to light that are not noticeable at rest. For most patients, cardiac CT is sufficient as the sole diagnostic method. A prerequisite for a precise CT examination of the heart is a relatively slow, regular heartbeat.

Health insurance companies do not yet pay for cardio CT

Doctors at the Berlin Charité have examined their patients for more than three years and have shown that cardiac CT is a very safe method to rule out a relevant disease of the coronary arteries. However, although the cardiac CT is not only gentler on the patient, it is also cheaper, the examination is not yet part of the service catalog of the statutory health insurance companies.

Cardiac MRI does not require X-rays

Magnetic resonance imaging (MRI) does not require any x-rays at all. With a stress MRI, the load on the heart is artificially increased by a drug in order to assess the blood flow to the heart muscle. A cardiac MRI can be used to clarify heart problems if the likelihood of narrowing of the coronary arteries is low.

However, the examination can also be useful in the case of medium to high risk. Because with the MRI, doctors can better assess the condition of the heart muscle, whether there are small injuries or inflammations, for example, or whether there is a clot somewhere in the heart. In contrast to the more expensive and dangerous cardiac catheter examination, cardio MRI is not yet part of the catalog of services of the statutory health insurance companies, so that the health insurance company decides on the reimbursement of costs in individual cases.

Experts on the subject

Prof. Dr. Thomas Meinertz, cardiologist
Former Chairman of the board of the German Heart Foundation
German Heart Foundation
Bockenheimer Landstr. 94-96
60323 Frankfurt am Main
(069) 95 51 28-0
www.herzstiftung.de

Prof. Dr. Ulrich Schäfer, chief physician
Cardiology, angiology, intensive care medicine
Kath. Marienkrankenhaus GmbH
Alfredstrasse 9
22087 Hamburg
www.marienkrankenhaus.org

Dr. Moritz Montenbruck, Senior Physician
Cardiac imaging
Center for Preventive Medicine
Kath. Marienkrankenhaus GmbH
Alfredstrasse 9
22087 Hamburg
www.marienkrankenhaus.org

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