He thought his heart was in perfect health. An advanced scan showed something alarming.
When Chris Abrunzo was in his early 20s, his father was struck by the kind of heart attack known as a "widow maker." The severe cardiac events are often fatal, and while Abrunzo's father survived, it inspired him to take his heart health seriously, since family history is one of the strongest indicators for developing heart disease later in life.
Abrunzo started getting regular cardiac checkups and he made sure to work out frequently and eat well. As the years passed, tests continued to show he was in great health except for some elevated cholesterol that he treated with medication. He had no symptoms of heart disease. In 2023, a family friend told him about a newer, more detailed test that offered a view of the arteries without any invasive procedures.
"I go in thinking I'm going to get a scan and be told 'You're doing a great job,'" Abrunzo recalled. "Well, I get scanned, and the scan reveals that I had areas of plaque buildup, many of which would not show up on an echocardiogram or a stress test, but that showed up on this scan. One of those areas was around 70% blocked."
High blockage in arteries can cause heart attacks. While the blockage Abrunzo found wasn't in a crucial artery, it was in a place that would be difficult to treat with surgery, so he knew he had to focus on reducing the buildup. He was prescribed more medications, and further adjusted his diet and exercise regimens. During a checkup last month, Abrunzo was told that the blockage was only occluding about 40% of his artery, putting him at far lower risk for a sudden cardiac event.
"I think this just the ability to look inside there is just something that's miraculous and probably saved my life, not in the very near future, but probably in my mid-50s," said Abrunzo, now 47. "It's like magic."
What is cardiac CT angiography?
A cardiac CT angiogram is a test that essentially conducts "a CAT scan for the heart," said Dr. Aeshita Dwivedi, a cardiologist at Northwell Lenox Hill Hospital. The full-body scanner captures 3D images of the heart and the arteries that supply blood to the organ. Some scanners can take the image in less time than it takes a heart to beat. Doctors can study that 3D image for blockages, plaque buildup, and other warning signs for cardiac disease, Dwivedi said.
It's far more advanced than what more common noninvasive tests, like the echocardiograms and stress tests Abrunzo was doing, can do.
"Usually you have to have greater than a 70% blockage in the arteries to have an abnormality on a stress test," said interventional cardiologist Dr. Tony DeFrance. "And that's really kind of a problem, because a lot of times people have echocardiograms, calcium tests, stress tests, and they say 'Oh, you're fine, your heart's strong.' That probably means they don't have a 70% blockage. But we've found out over the last couple of decades it's not the 70% blockages that cause the heart attacks. It's often the 20% and 30% blockages."
The test can also look at the plaque, or buildup of cholesterol, fat, blood cells and more that can narrow or block arteries. Vulnerable plaque, when found, is often a warning sign for a sudden cardiac event. More than half a million Americans die from such events each year, DeFrance said.
"Vulnerable plaques ... are the ones that when they tear or rupture, those cause heart attacks," DeFrance said. Stable, or calcified, plaque is less harmful, though it may cause chest pain and narrow the heart's arteries.
Expanding access to cardiac CT angiograms
Cardiac CT angiograms were first used in the early 2000s, said DeFrance, and the past decade has seen an increase in their use. He himself has founded the Society of Cardiovascular CT and trained thousands of physicians on the technology. In 2022, the American College of Cardiology issued guidelines recommending cardiac CT angiography as an evaluation tool for patients complaining of chest pain.
For Kim and Matt Mischo, expanding access to cardiac CT angiograms is personal. Matt Mischo believed he was in perfect health, but Kim, who worked in health care administration, convinced him to get a cardiac CT angiogram after she tested the technology herself during a work trip. She was worried about his family's history of heart disease, even as he insisted he was in good health and had never had any worrying cardiac exams before. Finally, the active husband and father of four underwent the test — and found that he was on the verge of a massive heart attack, with large blockages in multiple key arteries.
"I thought I was always invincible," Matt Mischo told CBS News. The news made him scramble to book an appointment with a cardiologist, and he was warned he might need open heart surgery and as many as three stents to avoid a major heart attack. Luckily, he was able to remove the plaque with an atherectomy, a minimally invasive procedure where plaque is removed with a catheter. The experience inspired the couple to open their own imaging center.
Since June, the Clear Heart and Lung Imaging Center has seen more than 300 patients. Kim Mischo estimated that of those hundreds, about 40% have found they had "some level of coronary artery disease." DeFrance works at the center, helping review the images taken and developing treatment plans for patients.
"The number one killer now, worldwide, is cardiovascular disease," DeFrance said. "Our current workup doesn't catch most people ... Our current paradigm is missing a lot. Working towards prevention, identifying the disease early so we have many more options, is crucial."
