EP370: Looking at Plaque in the Arteries - IVUS and OCT

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Episode Summary Introduction Dr. Warrick Bishop, a cardiologist, author, and CEO of the Healthy Heart Network, hosts this episode focused on advanced imaging technologies used to visualize arterial plaque. With heart disease claiming a life every 20 minutes in Australia, Bishop aims to educate listeners on how modern medical imaging can detect and understand plaque characteristics before cardiac events occur. Key Takeaways: Cardiac CT imaging is a non-invasive, external technology that effectively visualizes plaque in arteries before a person experiences a heart attack or cardiac event. Intravascular ultrasound (IVUS) uses high-frequency sound waves advanced down a thin wire to obtain detailed images of plaque from inside the artery. Optical coherence tomography (OCT) is an alternative technology that uses light instead of ultrasound to examine arteries and plaque characteristics with similar precision. Both IVUS and OCT allow cardiologists to visualize plaque composition, fibrous caps, calcification, and stability features to determine rupture risk. The "magic number" for LDL cholesterol is 1.4 millimoles per litre—achieving this level triggers plaque regression in over 50% of patients, as demonstrated by landmark studies (ASTEROID and Glargov). These invasive imaging technologies are primarily used clinically to guide stent placement and in research settings, not for routine screening of healthy individuals. Artificial intelligence (AI) is increasingly being integrated with IVUS and OCT to improve interpretation and analysis of arterial imaging data. Most heart attacks in Australia could be prevented with proper knowledge and prevention strategies regarding blood pressure, weight, and cholesterol management.