People at higher risk for heart attacks and strokes may be easier for doctors to spot in the future through testing for a specific type of cell.
Endothelial cells make up a thin layer lining the inside of the heart and all blood vessels and arteries. These impact clotting, how vessels expand and contract and play a role in the immune system.
Cardiovascular problems can cause these cells to rupture and flake off from the vessel and float in the blood, research shows. Research, including a study published in the medical journal PLOS One, indicates that if endothelial cells exist in higher numbers in the blood, it might be an early indication of potential problems like heart disease or risk of stroke.
Doctors believe the inflammation that happens when the cells break away from the vessel walls increases the chances of blood clots and slows blood flow, contributing to cardiovascular issues.
In short, testing for the presence of endothelial cells in blood might help predict heart attacks and strokes, according to The Scripps Research Institute, one of the world's largest not-for-profit biomedical research companies.
When a potential cardiology patient now goes to the hospital, doctors assess his thrombolysis in myocardial infarction, or TIMI, and HEART (history, electrocardiogram anomalies, the patient's age, risk factors present and elevated troponin, a protein complex involved in muscle contraction) scores to help determine the severity of his condition.
Test yet to be FDA approved
“Ultimately what this (test) is is another method of tracking,” said Kevin Roesch, administrative director of cardiovascular services for Franciscan Health. “When endothelial cells circulate at a higher level it is because they are being discarded because of inflammation that was in a blood vessel or within plaque or stable angina.”
Developments in the last few years have given doctors the ability to assess endothelial health through a relatively simple blood test. In the past, the blood vessel had to be surgically opened.
The “fluid biopsy” (the blood test), called the high-definition circulating endothelial cell assay, was developed by Scripps in 2014 and hasn’t yet gained approval by the Food and Drug Administration.
“A lot of this still needs to be validated,” Dr. Jay Shah said. “First of all, which population would benefit from the test, and No. 2, when you get the test and you get a result, what are you going to do with that? That’s still up for debate.”
Shah is medical director of the heart valve center, director of echocardiography and medical director of cardiac rehabilitation at Porter Regional Hospital. He’s also part of the American Heart Association’s speaker’s bureau.
He said a cardiologist already tells his or her patients to lose weight, not smoke, manage their diet and exercise.
“Right now, in 2018, there is no guideline that has been put out by the American Heart Association or the American College of Cardiology based off of cloud data that says 'Get this test in this patient population and then, based off of that, put them on drug X,’” Shah said. “We don’t have that data.”
Shah doesn’t perform the test and isn’t aware of anyone in the area who does.
Front of mind moving forward
Dr. Andre Artis, cardiologist and medical director at the heart and vascular institute at Methodist Hospitals, said he’s been considering the procedure since it was discussed at a preventative cardiology meeting last February.
“The biggest hurdle is figuring out what resources are necessary and whether or not it's a resource that we can afford at this time,” Artis said. “It's something that's kind of on the radar, but our windshield gets hit with so many new developments that you sort of prioritize what you think, from your perspective, is the most important. Though this is important.”
A blood test is certainly easier on a patient than most current heart-health screenings and cardiograms and may even be cheaper, Shah said.
But even as blood testing becomes more accessible and widespread, it’s not something that the average person needs to have done without the suggestion of a doctor.
“We don’t have the data to support mass screening of the entire population,” Shah said. “The jury’s still out on who should get that test. What guides the decision-making is looking at underlying risk factors such as diabetes, tobacco use, hypertension and also family history, in particular family history of premature vascular disease.”
The procedure is one of many things that may be a part of cardiology in the future.
“I think it’s very important that we treat heart issues after they happen, but I think people would agree that the best thing to do is to try to prevent it, and that is where medicine and in particular cardiology is heading,” Shah said. “If there’s testing that can assess risk in a particular patient, and we can get outcome data that this person would benefit from different therapies to prevent that heart attack, prevent that stroke, absolutely that is where this is headed.”
“Whatever we can do to prevent disease from happening in the future, I think, is the direction that our organizations are headed,” Artis said. “And this certainly is one of the tools that I think will probably be in the front of the mind for a lot of our clinicians for the next probably five or 10 years.”
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The miracles of modern medical technology surround us. Every day, there’s a news story that highlights the saving grace of new procedures and medicines. But for those in the trenches, there is another saving grace; the faith, family, and friends that make the battle worth fighting for one more day. The belief that there is a reason for everything. These are their stories.
16 years old
When Katie was born in 2000, her physician heard a heart murmur. That was the beginning of a whirlwind for both baby and her family.
Tests revealed that she suffered from Ventricular Septal Defect, or VSD. Katie had two holes in the walls of her heart, and a narrowing of the aorta. "We visited a pediatric cardiologist on Monday,” says Angela, her mother. “Katie had surgery on Thursday.” The surgery was performed at Ann and Robert H. Lurie Children’s Hospital in Chicago. Physicians believed they resolved all three problems during the procedure.
“She had a hard time eating,” Angela says. “She was still lethargic and cranky. We were afraid something wasn’t right.” Further tests revealed that the narrowing in the aorta had returned, along with a narrowing of the pulmonary artery. The diagnosis was Williams syndrome, a genetic disorder that causes cardiovascular and blood vessel problems.
The nerve-wracking trauma that the family had dealt with every day suddenly went up a notch. “They decided to do a second surgery,” Angela says. “My poor little girl was only six months old.” The surgery to reroute and reconnect her arteries was a success. Katie soon began to catch up to other infants her age.
Angela takes her faith from the little girl that has blossomed into an optimistic teenager proud to show off her scars, both mental and physical. “Katie was photographed for the Mended Little Hearts calendar,” Angela says. “She shared her scar to help others dealing with similar situations.” Beginning in 2017, Katie will speak on behalf of the American Heart Association, sharing her journey of faith and recovery.
“She has really taught us what a blessing every day is,” Angela says. “Many of us don’t realize what a true blessing it is just to wake up and be around those we love. Katie’s story has really helped all of us understand just how special today is.”
Katie remembers feeling different than others when she was younger. Today, she feels that difference is something to share. “I’m very proud of where I am today,” she says. “I want to speak for those who have a condition and tell them that fear, as well as disease, can be overcome.”
At age 50, Rick Lijana went to his doctor for what he described as “chest discomfort.”
“The doctor diagnosed me with GERD (acid reflux),” Rick says. “I was given medicine for heartburn and indigestion.” The diagnosis turned out to be a misdiagnosis. Rick suffered a heart attack a short while later. He received a stent after a balloon angioplasty was used to resolve the blockage.
A month later, the cardiologist detected other issues with Rick’s arteries, and a second stent was inserted through the same procedure. “At that point, I thought I was done,” Rick says. “I thought that they had found all of the blockages and that the two stents would resolve the issues.”
But Rick wasn’t so fortunate. He suffered a second heart attack just one month later. A third procedure resulted in two more stents being inserted into his arteries. “Over the course of three months, I suffered two heart attacks and had four stents inserted,” he says. “I felt very tired and very anxious.”
After a recuperation period, Rick began cardiac rehabilitation. The emphasis on physical rehabilitation did wonders for his physical condition. But, he was left feeling a need for more mental and emotional rehabilitation. “Even with the physical rehabilitation, I felt very anxious and strained,” he says. “I was afraid to eat. I lost fifteen pounds, and I was not overweight to begin with.”
It took time and work in order for Rick to build up the confidence needed to move forward. “I learned how hard it is to live,” he says. “It’s a challenge. But I also learned how much I wanted to live.”
Rick became very involved with the American Heart Association and United Way. He has organized fundraisers for the Go Red Campaign as well as other heart initiatives. “I enjoy helping others,” he explains. “I enjoy using my skill set to try and bring compassion to others who are suffering through some tough times.”
Rick emphasizes how important it has been to find ways to use his strengths on a daily basis. “Helping others makes me feel better,” he says. “It’s one of the ways I have used to overcome the mental and emotion strain of vulnerability.”
Ten years later, Rick still eats right, exercises, and lives a healthy lifestyle—mentally and physically.
When Chet and Cassie Nay decided to begin a family, they never envisioned the journey they would take. “We were like most couples,” Cassie says. “Excited to become parents, ready for a new chapter.”
But the shock of their newborn’s illness created a chapter no one expected. When Ethan was born in 2009, he was soon diagnosed with Ventricular Septal Defect. VSD is a hole in the wall separating the two lower chambers of the heart. “The doctor heard a heart murmur,” Cassie says. “We later learned that a heart murmur is a common symptom in children born with VSD.” The physicians explained that some children with VSD heal without surgery. The Nays began the tense phase of watch and wait. Their faith, along with the support of family and friends, helped to ease the anxiety.
Then, at six months, little Ethan developed a chronic cough and episodes of rapid breathing. It became obvious that his heart wasn’t healing on its own. Further tests revealed that the right side of his heart had enlarged, working extra hard to compensate for the hole in his wall. Surgery became a necessity. The family ended up at Advocate Christ Hospital and Medical Center in Oak Lawn, Illinois. “Cassie and I were able to stay at the Ronald McDonald House while Ethan went through with open-heart surgery,” Chet says. “It was a blessing in disguise. We had the opportunity to meet other parents who were going through struggles with their children.”
During the surgery to repair the hole, doctors also found a narrowing of the artery. They were able to clear out the narrowing during the same procedure. He came out of surgery a new little boy. “Ethan couldn’t crawl before the surgery,” Cassie says. “Afterwards, he crawled within days, and he walked at eleven months.”
Their prayers had been answered. Today, Ethan has a clean bill of health and a four-year-old brother named Elijah. “Even with everything we went through, we feel very blessed,” Cassie says. “We always believed it would work out, and in the end, he’s fine.”
The Nay family got involved in fundraising for the American Heart Association through Chet’s workplace. They believe in the research and support that AHA extends to all. And their belief extends to prayers answered.
When Amanda Woodworth was twenty weeks pregnant, she and husband Robert learned that their unborn baby had a heart issue.
After an ultrasound detected an issue, doctors performed a fetal echocardiography. This exam allows the doctor to better see the structure and function of the unborn child's heart. The exam uses sound waves that echo off of the structures of the fetus's heart. “The tests showed that our baby only had a singular ventricle, instead of two,” Amanda says.
She was able to carry the baby to full term, and Liam was born at the neonatal intensive care unit. He was only eleven days old when he had his first open heart surgery. “The first one was called pulmonary artery banding,” Amanda says. “It reduced the blood flow into Liam’s lungs.” The second procedure, called a bidirectional Glenn procedure, was performed when Liam was four months old. The third procedure, called Fontan, was performed when he was 23 months old.
The three surgeries rerouted the blood flow so that he can live a relatively normal life with only three heart chambers. The normal heart has four chambers. “They do not know what causes babies to be born with only one ventricle,” Amanda says. “It is the number one heart defect for newborns.”
Today, Liam is doing well. He has caught up with normal 4-year-olds, and only takes a daily baby aspirin. At one time, they told Amanda and Robert that Liam may take as many as ten medications daily. “Obviously, we were very shocked and upset at the beginning,” Amanda says. “But we have a strong faith, a good church group, and a lot of support from family and friends. Bob is the town marshal, and gets a lot of support from police organizations.”
Recently, Liam was able to drive in his father’s police car for the first time. He also played tee-ball this past summer. “We always watch and worry,” Amanda says. “I don’t know if that will ever go away. But our faith and Liam’s resilience have got us this far.”
The long-term diagnosis for someone with Liam’s condition is unknown. It is possible that he may need a heart transplant one day. Amanda says that the family will cross that bridge when they come to it. “In the meantime, we are just going to enjoy every day we have,” she says.
When she was 15 years old, Dianna began to feel episodes of chest pain and labored breathing. Doctor visits eventually led to cardiac tests, which in turn led to a diagnosis of mitral valve prolapse.
Mitral valve prolapse is a condition in which the two valve flaps of the mitral valve do not close smoothly or evenly, but instead bulge (prolapse) upward into the left atrium. In addition, cardiologists detected supraventricular tachycardia, an abnormally fast heart rhythm arising from improper electrical activity in the upper part of the heart. “I began to take medications for my racing heart and for my mitral valve,” Dianna says. “I was also instructed to improve my diet and exercise habits.”
Heart disease ran in the family. Dianna’s mother had already suffered two heart attacks, and has been diagnosed with congestive heart failure. Dianna’s brother passed from a heart attack at age 35. “I knew that I had to take my condition seriously,” she says. “I witnessed firsthand how heart disease had impacted my family.”
For many years, adjusted medication doses, along with proper exercise and nutrition, kept her condition in check. But last November, Dianna passed out while pumping gas at a station. “My friends, who were with me, took me to the hospital,” she says. “They stayed with me and were very supportive.”
Cardiologists performed a tilt table test. The head-up tilt table test is a way to find the cause of fainting spells. Dianna was placed on a bed and tilted at different angles, from 30 to 60 degrees, while machines monitored her blood pressure, electrical impulses in her heart, and her oxygen levels. No additional cardiac diseases were detected. However, her medications for both MVP and SVT were adjusted. In addition, they surgically implanted a link heart monitor just under the skin in her chest. The monitor remotely sends signals to her cardiologist’s office.
The steps taken help her deal with an ongoing problem. “I have to treat it as part of my everyday life,” she explains. “I grew up in church, and I have a lot of faith in my God. That helps me to get through the times of uncertainty.”
Dianna also has a passion for the AHA. She attends a fundraiser and walks every year. “And, I was a calendar girl for the AHA about four years ago,” she says proudly.