Welcome, my name's Dr. Warrick Bishop. I'm a cardiologist, an author and a keynote speaker. I'm CEO of the Healthy Heart Network. I'm all about trying to help people live as well as possible for as long as possible. Heart disease is huge in Australia. Every 20 minutes someone suffers a heart attack. Most of these could probably have been avoided if only we knew what to do. This podcast is all about helping you understand. blood pressure, weight, cholesterol, for better health. If you enjoy this podcast, I would be honoured for a five-star review. You can share it with your family and friends. It may well save someone you love. Hi, my name is Dr. Warrick Bishop. Welcome to my podcast and videocast station. As always, I'm really grateful you've tuned in and I hope I can share something that you find valuable. Today, I'm pretty keen to talk about how we look at plaque in the arteries. Anyone who's listened to my podcasts or read my books or followed me on Facebook, you'll know I'm particularly interested in imaging the arteries in well people before they've had an event to try and understand if there's plaque in the arteries or not. And the technology that we use for that is cardiac CT imaging, really using CT scanners, but they're, if you like, modified, the particular studies are modified a little bit so that we can capture the heart. Because if you think about it, the heart beats and moves. So if we're taking pictures of the heart, accounting for that movement is really important. Well, CT is a really good way of looking at the plaque in the arteries from the outside. within the arteries from within the heart. That's pretty amazing. If you think about it, when someone has a stent put in place, that's the little metal scaffold that goes into a narrowing in the artery and then gets blown up, then you can understand that we're able to put things down arteries, things like wires for guiding. Well, When we're in the situation where we can put things down arteries, one of the things that's really important to understand is that we can put imaging tools down those arteries. And those imaging tools are what I'd like to talk about today. When we look at the way we can acquire images from within an artery during the time that we've got a catheter or a tube, In a patient's artery, there are two main types of technologies that we can use. One is called intravascular ultrasound, intra, within, vascular, within the blood vessel, ultrasound, meaning high frequency sound waves. We refer to that as IVUS, intravascular. ultrasound. So if I use the term IVUS, you know I'm talking about using incredibly fine small ultrasound probes within the arteries to look within the artery and look at plaque and characteristics literally inside the coronary artery. Pretty amazing. The other technology is called optical coherence tomography. Now optical coherence tomography instead of using ultrasound, uses light, optical light. And what it does is it shines a bright light around and inside that artery, looking for reflections. A little bit like the intravascular ultrasound, but using light instead. Now, these technologies both can be advanced down an artery on a very... thin or small wire, and they can be used to get exquisite images of exactly what's going on with that artery. In particular, it gives us a chance to look at the plaque. It gives us a chance to look at the fibrous cap over the plaque. We get to see calcification. We get to see features of stability and not. So this is pretty amazing. Where are these technologies used? Well, often they're used to help the interventional cardiologist, the person who's putting a stent in, to be most precise with knowing exactly where the plaque or the offending problem may be beginning and ending because sometimes there could be a significant trail of cholesterol either side of where a narrowing occurs individual putting in that stent to make allowance and therefore make that stent long enough to cover all the areas that could be at risk. Well, these technologies are brilliant for allowing implantation of stents, but they're also brilliant for allowing some research to be done when we're looking with very high resolution at very small changes within plaque. And both IVUS and OCT have been used sequentially in lipid lowering trials to evaluate the impact of significant cholesterol lowering on plaque characteristics. Well, this is super important because the more we understand about plaque characteristics, the more we can know whether we're improving a plaque in terms of reducing its risk of rupture or not. Well, the really interesting thing about these technologies is both IVUS and OCT have been used in these clinical research scenarios, and both IVUS and OCT. with the asteroid study and the Glargov study respectively, have shown us that we can reduce the fatty plaque component of plaques. So we can reduce plaque size if we can get LDL cholesterol down low enough. And the number, the magic number is 1.4 millimoles per litre. That will lead to plaque regression. as demonstrated by IVUS and OCT serial evaluation in over 50% of individuals. And these are the sort of study results that drive the guidelines that inform our practice. So amazing technology using ultrasound down an artery or light down an artery to give us these magnificent images that can allow us an assessment. of the characteristics of a plaque. Now, as I've alluded to, these technologies are used with some regularity in a clinical context to help the interventional cardiologist in placement of their stents, but they are also used in research. Well, where is this technology going to go? Of course. We're constantly looking for improvements in the way these technologies can be used. And there's no question that we're now seeing AI come into, that's artificial intelligence, AI come more and more into our clinical practice. And so there's every chance that we'll see these technologies combined with AI tools to help in the interpretation and reading of the information that's obtained. So pretty amazing. Now, I'm not suggesting that you run out and get Ivis or OCT done on your arteries. This is really something that's for people who need it done. So you need to have something wrong with your arteries or you really need to be in a very clear study setting. This is not. for the average person off the street. And I'd like to remind you that one of the really, really good ways to see if you've got plaque in your arteries is to use a CT scanner, which is external and non-invasive, but pretty amazing. IVUS, intravascular, ultrasound, and OCT, optical coherence, tomography, beautiful technologies to give us exquisite images, really informing us about. plaque morphology, plaque characteristics, and even fibrous cap information. Well, I hope you find that informative. I've really been enjoying some of the questions that people have been shooting my way lately. So if you do have any queries or questions on this or on something else, please drop me a note at info at drorickbishop.online. It is my pleasure to try and answer those questions. If you've enjoyed this, please share it. or subscribe, or both. I hope, again, it's information that you find valuable. Till next time, of course, I am going to wish you the very best. If you are interested, check out my new book, 10 Commandments of Heart Health Explained. I've had some really nice feedback. The stories in there are, I think, really engaging, and they're real people. So check it out. For now, I wish you the very best. I hope you live as well as possible for as long as possible. Take care. And bye for now. Join the Healthy Heart Network and become part of our growing community. If you're interested in your heart health and risk of heart attack then join the Healthy Heart Network for only $5 as a lifetime member. This represents $55 worth of value. We offer and help people understand their present state of heart. health, what their current level of risk is and the positive steps they can take to improve their risk of heart attack in the future. Go to www.healthyheartnetwork.com.au and click the join the family button.
