JOIN USIndia is today experiencing a rapid transition in the disease burden and is gradually moving towards a scenario where majority of deaths are caused by lifestyle diseases. A large number of people are leading unhealthy lifestyles, which have a major impact on their health. Cardiovascular diseases (CVD) pose huge social and economic concerns for India, and the steady upswing in the mortality attributed to CVD is challenging, contributing to more than a quarter of all deaths.
While there are certain risk factors that cannot be controlled (age and genes), most other factors, like physical inactivity, unhealthy diet, smoking, alcohol consumption and inappropriate sleeping routines, are avoidable. In order to combat the rising incidence, we need to strengthen preventive measures by adopting healthy habits. However, there are times when the damage caused by a consistently unhealthy lifestyle
cannot be reversed and need the right form of medical intervention. In this regard, to ensure
that heart ailments are managed appropriately, we need efficient and precise diagnostic and treatment measures.
Fortunately, one such method of technology is utilised in the area of treatment of coronary artery disease while performing angioplasty. Advanced tools like Fractional Flow Reserve (FFR) and Optical Coherence Tomography (OCT) used in the treatment of cardiovascular disease are very helpful.
FFR is a hi-tech microsensor technique which measures the blood pressure and the flow in an artery. It measures the blood flow denoted by quantitative values, which helps a physician to decide if stenting is required or not. An FFR value of 1.0 represents normal blood flow, a value greater than 0.8 means that the blood flow is adequate and the patient can be treated through medication. However, an FFR value less than 0.8 means
blood flow is inadequate and the patient requires stenting/surgery. This measurement is useful for physicians to take appropriate treatment decisions.
A 56-year-old patient who was suffering from a coronary artery disease (CAD) and had earlier undergone angioplasty visited me for a doubtful lesion. The same was evaluated by Sestamibi scan, which showed that it was normal and hence was treated with medication. Further, a cardiac MRI was done which showed that there was significant ischemia in LAD territory. Thus, FFR was conducted to ascertain the next step
of treatment. The FFR showed a measurement of 0.73 and on that basis we decided to place a stent to remove the blockage. The procedure was done successfully and the patient is doing well now. This is a clear example of the efficacy of FFR in the case of borderline lesions.
Further, OCT is an imaging tool which is very accurate technology and provides high-resolution (HD) images of the inside of the arteries. By using this imaging tool, physicians can assess the characteristics of the blockage along with the diameter of the artery where the stent needs to be placed. After stent placement, OCT helps to check if the stent has covered the whole length of the blockage and is appropriately placed. Thus, it helps in pre and post-procedures, thereby, improving patient outcomes.
Enhancing treatment
Evidently, technologies like FFR and OCT provide us with physiological and anatomical insights respectively to improve the diagnosis and effective treatment of patients. They enhance our ability, as physicians, to prescribe correct treatment by better identifying significant blockages and also reduce re-admissions. This immensely contributes to better long-term clinical and patient outcomes.
Every patient has a different treatment need and these tools help to customise the strategy based on their individual requirements. It saves the patients from undergoing unnecessary procedures/ surgeries and its associated risks/ complications, also thereby, providing more cost-effective treatment.
In a nutshell, what holds paramount importance is the prioritisation of health in the context of current transition and strengthening of the health-
care system. In order to promote
good cardiovascular health, the ideal approach would be to
have diagnostic capabilities and such advanced technologies, so treating physicians can provide evidence-based and correct treatment for their patients.
To prevent India from becoming the heart disease capital of the world, there is a need to instill 'healthy living' as a norm. The responsibility also lies with the medical fraternity to leverage newer techniques which can effectively manage the disease, eventually reducing its overall burden.
(The writer is Senior Cardiologist, Narayana Hrudayalaya Institute of Cardiac Sciences, Bengaluru)