A comprehensive case study that Dr. Castellanos and John-Lloyd Santamarina completed, showing the positive effects of lifestyle changes, biofeedback and the effectiveness of the bi-directional doppler ultrasound as a “global” assessment tool in the reversal of Cardiovascular Disease.
This case study was submitted as an entry to the American College of Cardiology 62nd Annual Scientific Session and Transcatheter Cardiovascular Therapeutics (TCT) conference held in San Francisco early 2013, but was not selected for presentation. Dr. Castellanos suspects that this is due to the conference weighing more heavily towards procedural interventions over lifestyle.
The abstract of the study is as follows:
Introduction: This case dramatizes the complex nature of standard of care in the evaluation and treatment of acute coronary artery disease. Concerns over the invasiveness and costs of standard procedures have led to the search for alternative methods that allow earlier recognition of vascular disease. Bi-directional spectral Doppler waveform analysis is a proposed approach in this study.
Case Presentation: In this case, the patient had long been evaluated in the office with a non-invasive tool (the ultrasound) diagnosing vascular disease. Patient had also been placed in a lifestyle program for its reversal. Through patient’s choice she failed to follow those recommendations and had stopped reporting for evaluation. A few months later, she had an acute coronary syndrome, forcing her to be evaluated by standard of care protocol using invasive evaluation and intervention methods: angiograph and stent placement on her arteries, respectively. But, even with these invasive procedures, the left coronary artery was discovered to have severe plaque rupture and thrombus that the interventional cardiologist had no option other than to defer intervention to avoid further disruption. Thus the patient returns for treatment with primary doctor, who emphasizes lifestyle protocol, and using Doppler analysis on a weekly basis to track and measure progress. At six weeks, she returned to the interventional cardiologist, where re-catheterization showed resolution of plaque and clot, therefore not necessitating stent, angioplasty, nor by-pass surgery.
Discussion: The study provides evidence in the following: the effectiveness of lifestyle management, supported by Doppler analysis; the strength of Doppler analysis as a biofeedback tool; and the application of Doppler analysis as a “global” assessment tool for vascular health, measuring posterior tibial and dorsalis pedis as representations of coronary artery disease. Doppler analysis has its limitations in procedure and interpretation. Further research and resources are therefore necessary to elevate its status as a non-invasive, non-radioactive, and inexpensive assessment tool, that can also be used as a supplement to medical treatment thru biofeedback principles.
The complete text in pdf format is available below:
Introduction
Standard of health care for coronary artery disease follows this pattern: onset of symptoms (e.g. chest pain, heart attack, or stroke), diagnosis of disease, commencement of treatment.
Traditional diagnostic procedures may involve cardiac catheterization, intravascular ultrasound, electrocardiogram, coronary computed tomography angiography, single photon emission computed tomography, and magnetic resonance imaging.8 Preferred methods for treatment are drug therapy, angioplasty, stent placement, or by-pass surgery.13
But, due to the rising costs of healthcare6, multiple concerns over invasive procedures7, and the persistence of Heart Disease as one of the leading causes of death12, U.S. and AHA has been searching for alternative methods that are less invasive and less costly.4 There are even studies that claim there is a shortage of cardiologists, particularly interventionalists,3 but many believe that we should actually be promoting primary and proactive care. This case study proposes a solution: Bi-directional spectral Doppler waveform analysis for the “global” assessment of vascular disease (i.e. coronary, cerebral, renal, peripheral), used in early recognition, and for applying biofeedback principles to increase the efficacy of treatment, especially that of lifestyle interventions.10,14
Doppler analysis is non-invasive technique9 typically used to analyze Peripheral Arterial Disease (PAD)2, however studies have shown a correlation between the endothelial function of the peripheral arteries and of the coronary arteries.15 Therefore, Doppler analysis is applied as the “global” assessment tool that provides analysis of overall arterial health and early detection of arterial disease.1
Doppler analysis is also used as a supplement to medical treatment (drug therapy, lifestyle intervention, etc.) thru the application of biofeedback principles. Biofeedback is the process of looking at signals from the body (i.e. heart rate, blood pressure, weight, etc.) to give an insight into a person’s health.11 These signals are used to elicit appropriate responses, like enforcing positive habits and foregoing negative ones. Doppler analysis provides such responses, by giving an insight into arterial health and allowing continual patient engagement.
