Preventing infarction

How much at risk am I? Ever since 55-year-old Cora Dubach’s* brother had a heart attack, she’s been wondering whether she might be at risk too. So she’s decided to have it checked out. The most significant factor in the prognosis is deposits in the coronary vessels, which can lead to advanced circulatory disorder or even an obstruction, preventing parts of the heart from receiving sufficient blood or any at all. This results in heart attacks, chest pains (angina pectoris), or cardiac insufficiency, the most frequent causes of death in western industrial nations.

“We can use a CT scan to identify changes in the coronary vessels early on,” explains Ronny Büchel, Senior Attending Physician at the University Hospital Zurich (USZ) Department of Nuclear Medicine. So far the problem has been that in the course of every person’s life, their vascular walls accumulate deposits of blood lipids, clots, connective tissue, and calcium. What isn’t clear is which deposits lead to a heart attack and which don’t. Even the degree to which these deposits restrict the flow of blood isn’t an adequate indicator, because three-quarters of the deposits that result in infarction don’t limit the flow by even 50 percent.

Now Ronny Büchel has joined forces with resident physician Andreas Giannopoulos to develop a three-dimensional computer simulation that shows how the circulation is affected by different types of deposits. If, for example, the blood stagnates, it can lead to inflammation. If there is too much pressure on the arterial walls, it can result in tears. For their research, the two physicians are also using data from patients who have repeatedly had their heart examined. This way they can see how the situation changes over a period of years.

The goal: “We want to work out clearly measurable parameters to be able to make better decisions on whether and how to treat patients like Cora Dubach preventively, for example with drugs or a stent to keep the blood vessel open.” Their research is supported by a donation from the Iten Kohaut Foundation to the USZ Foundation.

*anonymized