3D-CCG - Vasculargraphy

3 D Vasculargraphy was introduced to Pune, by GHF about 15 years ago as a new advanced non invasive technique for early detection of Coronary Artery Disease. It measures the blood flow to the various regions of the heart. It is affordable, painless and no side effects. A detailed 10 pages report is generated in 20 minutes.3 D Vasculargraphy is useful for patients who want to determine the extent of heart disease, follow up after angioplasty / bypass surgery to detect reoccurrence.

In conventional cardiology which is being practiced currently all-over, Cardiologists wait for the blockages within arteries to mature to a moderate or critical stage, before they can perform an Angioplasty or By-pass surgery. The Vasculargraphy Scan technology is relatively new, just about 7 years old, as compared to Angiography, which has been there for 40 yrs. Therefore, most doctors are not aware since it was not taught to them during their study program. The sensitivity of Vasculargraphy is 91%, and the specificity is 92% in correlation with Angiography. Vasculargraphy meets all the necessary international certification and is in use in over 15 countries worldwide.


Non-invasive / No hospitalization required  
No injection / Radiation  
No pain or risk  
Flow reduction of even 20% detected  
Also can be used for follow-up after Angioplasty & By-pass.  
Procedure takes only 30min.  
 

Tests for measuring cardiovascular Functions and blood flow :

 

The general emphasis in cardiology today is on the anatomy of coronary artery disease; that is, which coronary arteries are involved, and how much narrowing or obstruction there is. Increasingly it is becoming evident that the amount of narrowing of the coronary arteries is of only minor importance. Such narrowing does not correlate with the patient's symptoms, the motion of the muscular walls of the heart, the performance of the heart, the blood flow through the coronary arteries, the patient's prognosis, and the results of coronary artery bypass surgery.

It is important to know how well the heart is functioning and how much is the blood flow reduction rather than knowing the extent of blockages. A number of new diagnostic tests are available for this purpose. Collectively these tests and procedures are called non-invasive test because they do not invade the body or penetrate the skin. One such test is the Vasculargraphy

 
     
     
     

 

Vasculargraphy


What is Cardiovascular Cartography ?

It is a new advanced non-invasive technique for early detection of Coronary Heart Disease. It measures the blood flow to the various regions of the heart. If there is a significant reduction of blood flow, it is suggestive of the presence of obstructions in blood vessel, which is decreasing the blood flow. It also provides an assessment of the functional status of heart, including the pumping capacity of the heart, stiffness of the blood vessels, and the tendency to form a clot etc. The information obtained from Cardiovascular Cartography is not provided by any of the existing cardiac diagnostic tools and some of them were never possible earlier by non-invasive method.

What technology does Cardiovascular Cartography use ?
The technology used is Trans-Aortic Signal Wave Modulation (TASWM). A 150 KHz signal is passed through the generating electrodes, which travel along the aorta (the largest blood vessel in the chest cavity) and is modulated by the ejection of blood, breathing activity as well as electrical and mechanical activity. The signal is then picked up by the measuring electrodes and demodulated. Low bandwidth cardio subsonic is recorded using a special instrument called VAD (Vertical Acceleration Detector). This technology is called Flow Turbulence Accelerometry (FTA). There is a difference in the turbulence characteristics of normal and abnormal vessels. Any obstruction due to blockages disturbs this smooth flow of blood and produces characteristic turbulence. This turbulence is detected by the VAD and provides as to which region of the heart is experiencing reduced blood flow. The technique is similar to how a Seismography picks up vibrations kilometers inside the earth and lets us know whether an earthquake has occurred. The blood pressure is obtained using an automatic continuous Non-invasive Oscillometric Blood pressure measuring technique. The data, which is acquired, is processed using powerful and advanced mathematical modeling and simulation tools and high speed computing and then various parameters obtained.
What is the procedure?
The patients height, weight and body shape are measured and the information fed into the CCG monitor. The patient is made to lie on the bed and the skin over the chest is gently swabbed with spirit. Disposable electrodes are placed on various specified locations on the chest wall and connected to four pairs of leads for generating and measuring signals. Four leads for the Electrocardiogram are also placed on the chest wall. The blood pressure cuff is fixed to the patients arm and the basal test started. The second part of the test involves the administration of a drug called Isosorbide Dinitrate (Sorbitrate) placed below the tongue. This drug causes an increase in blood flow to the heart. The test is then repeated. In some cases the test needs to be done in a head –up position. The whole procedure takes about 15-20 minutes
Is there any protocol to be followed?
The person has to observe fasting for a period of 10-12 hours before the test. It is important to abstain from tea, coffee or soft drinks during the period of fasting. Medicines for the heart and blood pressure should also be withheld for 8 hours. If the person has diabetes, he can have his diabetic medicines. It is also advised not to smoke or take alcohol for a period of 24 hours before the test. Morning walk or any strenuous physical exercise should be avoided on the morning of the test. Water or a glass of plain milk can be taken if required.
What are the advantages of Cardiovascular Cartography?
3D-CCG is totally non-invasive. There is no injection, no catheterization, no anesthesia, no hospitalization and no radiation. Since it is non invasive there is no pain, no risk and no after-effects including no physical or mental strain. It is useful in early detection of Heart disease; even a small blood flow reduction caused by even blockages as low as 20% can be detected. It also assesses the functional status of heart and helps in selecting the correct drug for preventing heart attack and controlling hypertension. It can be repeated several times unlike invasive methods and hence can be used for assessment. It also serves as a motivating factor to undertake lifestyle and diet changes and thereby prevent heart attacks.
Who can undergo Cardiovascular CartographQ: Is there any protocol to be followed?
The person has to observe fasting for a period of 10-12 hours before the test. It is important to abstain from tea, coffee or soft drinks during the period of fasting. Medicines for the heart and blood pressure should also be withheld for 8 hours. If the person has diabetes, he can have his diabetic medicines. It is also advised not to smoke or take alcohol for a period of 24 hours before the test. Morning walk or any strenuous physical exercise should be avoided on the morning of the test. Water or a glass of plain milk can be taken if required. y ?
  1. Any adult can undergo the test as a screening method for early detection of heart disease.
   
  2. It is very useful for all high-risk persons irrespective of age
  • People with high cholesterol levels?
  • Those who have high blood pressure
  • People who smoke regularly or take tobacco.
  • Those who consume alcohol regularly
  • Overweight persons
  • Individuals having Diabetes
  • Persons with relatives having heart disease
  • People with minimal physical activity or sedentary lifestyle
  • People who lead a stressful life.
   
  3. Those who cannot undergo Tread Mill Test (TMT) due to physical discomfort, can undergo Cartography like
  • People with Arthritis
  • Very old people, Sick people
  • Physically challenged
  • Pregnant women
  • Respiratory disorders
   
  4. Those who have chest pain can find out if it is due to the heart or not.
   
  5. Vasculargraphy is useful for Heart patients
  • To determine the extent of heart disease (Previous heart attacks)
  • To monitor effectiveness of their treatment.
  • Follow-up after angioplasty (PTCA) to detect recurrence.
  • Follow-up after by-pass surgery (CABG)
   
How does Vasculargraphy help in detection of Coronary Artery Disease? 
The invasive procedures and imaging devices detect the extent and location of blockages in major vessels, whereas, the Vasculargraphy measures the blood flow of the heart muscle and provides information on how much blood flow is being reduced by the blockages. Coronary artery disease contributes to blood flow reduction in over 70% of cases. It is the blood flow reduction, which are the cause of the patient's symptoms and not the anatomical presence of blockages.
What is the other information that can be obtained from a Cardiovascular Cartogram? 
Cardiovascular Cartography also provides information on functional status of the heart. It tells you what is the amount of blood pumped by the heart in one minute (Cardiac output), how much resistance is there against which it has to pump (Systemic resistance), how much volume it is pumping during every beat (Stroke volume), what proportion of blood is pumped (Ejection fraction) etc. All these parameters are extremely useful in assessing how well the heart is functioning. It also helps the physician to choose the right drug for the high blood pressure (hypertension) or other heart problem. It also provides information on whether a person has atherosclerosis (hardening of the arteries due to cholesterol deposits), whether he has a tendency to have erratic beats (arrhythmogenicity) and whether he has increased chance of forming clots (thrombogenicity), how much is the burden on the heart etc. In short it can be called "Heart Function Test" just like liver function tests and lung function tests.
How does the patient obtain the results of the Cardiovascular Cartography?
The Vasculargraphy machines generate Cardiovascular Cartography measurement report automatically after the test is completed and hence there is no scope of subjectivity. A doctor specially trained in Cardiovascular Cartography is required to interpret the findings. Once the trained doctor has reviewed all the reports, the trained doctor is sent along with the report to the ordering practitioner who prepares a summary report. The practitioner then reviews the report of the cardiovascular Cartography with the patient and correlates it to their particular symptoms or condition. Frequently, many circulatory related abnormalities, that were never expected is revealed, when the trained eyes focus on the reports. The report is user-friendly and easy to understand by anyone with some knowledge on cardiovascular physiology and functional medicine. Cardiovascular physiology and functional parameters were not available non-invasively earlier, limiting their application all these years. Imagine if we had to drill a hole on the hand and insert a probe deep inside to measure the body temperature, nobody would have used temperature as a parameter to establish fever. Because it is easy to measure body temperature, it is used as an important functional parameter.
How accurate is Vasculargraphy in detecting CAD?
The accuracy of any diagnostic test is measured by its sensitivity and specificity. Studies show that Vasculargraphy has a higher sensitivity and specificity when compared to other non invasive test like Electron Beam CT, PET scan, Stress Thallium, Stress Echo and TMT. The sensitivity of CCG is 91% and the specificity is 92% in correlation with angiography, while the TMT has a mean sensitivity of 65% and a specificity of 77%.
I recently had a stress test that was perfectly normal but Vasculargraphy showed that I have reduced blood flow to the heart. Does that mean either this test or the stress test was wrong?
No. Although both tests were looking for heart disease, they are doing it in different ways. Your normal stress test indicates that the plaque build up has not yet reached the point where the blood supply reduction is causing abnormal electrical activity, which can be picked up by an ECG. Your cardiovascular cartography measures the actual reduction in the blood flow and tells us that the process has indeed begun, and there is an opportunity to modify all the controllable risk factors to minimize the chance of having a major heart related event.

 

I have no major risk factors for heart disease, I exercise regularly and I am very careful about my diet. Should I undergo this test?
 It is important to continue following a "heart-healthy" lifestyle and it is likely that your heart has benefited from your modified lifestyle. There are a few factors that we can never control for example our age, gender and genetic predisposition (family history). For some individuals, reduced blood flow to the heart muscle may be the only indication that they may be at higher than expected risk for a heart attack. Hence it is advisable for all adults to undergo this test.
What are the limitations of Cardiovascular Cartogram?
Vasculargraphy does not measure the actual anatomical location or extent of blockages. Hence for a person who is contemplating surgical intervention like Angioplasty and By-pass surgery, it would be useful only to the extent of functional assessment of the heart and circulatory system, which may be useful in prognosis of the surgery but not for planning the actual surgery or angioplasty. Moreover, it does not give any data on structures of the heart like the muscle wall or any anatomical abnormality of valves, except the functional, dynamic valvular orifice area.
Why is Vasculargraphy not widely known?
The technology is relatively new, just about 3 to 4 years old, when compared to other techniques like angiography, which has been there for 40 years. Most doctors were not aware of its uses as it was not part of their curriculum during the time of which they had learnt of the already existing technology. However all the functional parameters provided by Vasculargraphy and their significance is being taught to current medical students in medical colleges. Vasculargraphy meets all necessary international certifications, and is in use in over 15 countries worldwide.
My doctor has never told me about this procedure. Why is it so?
Cardiovascular cartography is a relatively new, highly specialized and sophisticated technology. There are now hundreds of published papers on importance of blood flow measurements. However most of this information is in sources read primarily by few doctors. Please keep in mind that it is quite lightly that your physician does not yet know about this technology or the utility of the test.
Can you tell me how much blockage there is in my coronary arteries?
Although it is possible for us to make some conclusion about the degree of coronary narrowing that is likely to exist, based on the amount of blood flow reduction, it is not a primary purpose of this test. The primary purpose of the test is to detect diseases before there is much narrowing. Doctors now know that more than half of all heart attacks occur at size of less than 50% narrowing. No other non-invasive test in cardiology can detect this type of early diseases.
I had a Vasculargraphy test that showed that there was reduced blood flow to my heart muscles. I did an Angiogram and found that I had a normal blood vessel. But I still have chest discomfort. Was the Vasculargraphy wrong? 
No, neither Angiography nor a Vasculargraphy scan was wrong. Angiography proved the reasons for your blood flow reduction, and thus your symptoms were not due to the blockages in your main blood vessels of the heart. There are nearly ten main causes for the reduction of blood flow to the heart, blockages being one of them. The Vasculargraphy reports can reveal what could be the other reasons for your symptoms and the reduced blood flow.
   
I had a Vasculargraphy test done it showed that I have normal blood flow to my heart. I went through an angiography procedure and found I have 100% block in one vessel and 80% in the other vessel. Was the Angiography right?
Yes, both the Angiography and Vasculargraphy is right. Angiography measures the blockages that measure 100%. Well! Patients having such high-grade disease would have already developed excellent collateral circulation. If it were not for the “natural bypass" of that vessel, the 100% blockage would have caused a heart attack in that region of the heart. Vasculargraphy measured this flow, which a doctor can see if is trained to view an angiogram carefully.