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VA unveils new technology in second cardiac cath lab
By Shelia Watson
Contributing Writer
The Ralph H. Johnson VA Medical Center has opened its second cardiac catheterization lab, which features technology with specialized software that transforms intravascular ultrasound images into color-coded pictures of the vessels in the heart.
The lab is the next step in the Charleston facility’s quest to become a VA Cardiology Center of Excellence for the Southeast, according to Tonya Lobbestael, public affairs officer for the RHJ-VA.
“We want this to be the place where patients are referred for high-tech procedures like this,” she said.
The RHJ-VA is the only medical facility in the Lowcountry to employ the “virtual histology” intravascular ultrasound, a catheter-based technology for diagnosing vessel geography and plaque morphology from within the coronary artery.
The images in conventional intravascular ultrasound, referred to as IVUS, are displayed in grayscale on a computer console in the cath lab. Virtual histology IVUS uses advanced software to provide color images of the plaque in the arteries in addition to the conventional grayscale images. The images show whether the plaque in the vessels is hard or soft, which allows cardiologists to plan the stenting procedure more accurately. The procedure also is used to check placement of stents after the procedure is completed.
The virtual histology images can show plaque areas that are more likely to rupture and cause future heart attacks. Coronary heart disease is the nation’s single leading cause of death, according to the American Heart Association. This year 1.2 million Americans will suffer a heart attack, and 502,000 of them will die.
Dr. Valerian Fernandes, one of six attending physicians at the RHJ-VA trained to use the diagnostic tool, said virtual histology IVUS may help prevent the all-too-common cases in which apparently healthy people suffer heart attacks.
“Traditional angiograms show what’s inside the vessel, but they don’t show the wall itself,” he said. “There’s a lot of disease in the wall and we want to look at that. Using virtual histology is like putting it under a microscope.”
According to studies by the American Heart Association, 60% of heart attacks occur in people who have plaque buildup in their arteries that is not considered severe. In many cases, such blockages are not evident even during a stress test, in which the heart is monitored while the patient is on a treadmill.
If a microscopic study of the blood vessels is done, it shows only minor blockages that do not appear to require treatment. However, virtual histology uses a computer to map the blockages and, more importantly, to analyze their composition.
The virtual histology IVUS breaks down the plaque by color, showing red for cholesterol, white for calcium and green for fiber. Fernandes said plaque buildup composed largely of cholesterol is far more dangerous than deposits composed of calcium or fiber, two other building blocks of plaque.
The RHJ-VA has been using conventional IVUS equipment for four years. The virtual histology was installed three months ago. Fernandes said the VA is working with the Medical University of South Carolina to study the best uses for the technology.
“Virtual histology has great research applications and predictive applications,” Fernandes said.
The lab performs an average of four procedures per day using virtual histology IVUS. Along with the six attending physicians, about a dozen fellows in training, many of them from MUSC, will work three months at a time with the RHJ-VA to learn the procedure.
Currently, the only way to administer a virtual histology IVUS is by catheter, but several studies suggest that within a few years, the procedure may be done non-invasively with an MRI scan.
Annually the RHJ-VA performs more than 1,000 cardiac and peripheral catheterization procedures, including diagnostic tests, pacemakers, defibrillators, balloon angioplasty, rotablations and stent implants. The additional lab and advanced technology will enable the facility to better meet the growing needs for these procedures in an aging veteran population.
The VA’s cardiac cath labs also perform electrophysiological studies to map the electrical conductivity of the heart. These procedures are used for both diagnosis and correction of electrical arrhythmia by making new scars to re-map electrical pathways for the heart.
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