Stress Tests vs CCTA: Stress Tests Are Late Signals

Dr. Kim Brockenbrough: https://www.cardiavision.com/https://www.linkedin.com/in/kimberly-brockenbrough-md-1b321a123/https://www.instagram.com/kimbromd?ighsh=YjVpcDcwdHA3ejVvYour calcium score came back zero. You're in the clear, right? Not so fast.In this episode, Optispan Clinical Director Dr. Nicki Byrne sits down with Dr. Kim Brockenbrough, board-certified cardiovascular radiologist, 25-year veteran of vascular imaging, and CEO of CardiaVision, for a conversation that challenges one of the most common assumptions in preventive cardiology.If you care about cardiovascular longevity, and you should, because heart disease remains the leading killer, this is the imaging conversation you didn't know you needed.Timestamps:00:00 — Cold open: The 48-year-old runner with an 80% blockage and a zero calcium score00:54 — Dr. Nicki Byrne introduces Dr. Kim Brockenbrough & CardiaVision01:45 — Dr. Brockenbrough's background: 25 years of vascular imaging02:35 — Cardiovascular disease through a longevity lens: imaging vs. labs vs. functional testing03:24 — The lifecycle of plaque: from fatty deposits to rupture and heart attack04:21 — Why soft plaque is more dangerous than calcified plaque (SCOT-HEART 2020)05:14 — How calcium scores are used in clinical practice — and where they fall short06:18 — The only way to see soft plaque non-invasively: coronary CT angiography (CCTA)07:08 — Which populations are most at risk of a false sense of security from calcium scoring08:03 — What a CCTA can tell you that a calcium score can't09:43 — How often should patients follow up with repeat scans?10:28 — Higher vs. lower dose radiation protocols — and why Dr. Brockenbrough chooses higher dose11:17 — Risks of CCTA: contrast reactions, kidney considerations12:15 — Stress tests vs. CCTA: why a negative stress test is a very low bar13:21 — Soft plaque that isn't flow-limiting: small emboli, dementia, and congestive heart failure15:36 — Medications that reverse plaque: statins, PCSK9 inhibitors, and the LOCATE trial16:23 — LDL reduction and plaque regression: what the data shows17:08 — High-intensity statins vs. Repatha — tolerability, efficacy, and the price drop18:27 — When OptiSpan reaches for PCSK9 inhibitors: ApoB, LDL, Lp(a), ApoE4, and significant disease19:22 — Why a rising calcium score on a statin is exactly what you want to see20:25 — AI plaque quantification tools: promise, limitations, and validation concerns22:54 — Has AI ever changed Dr. Brockenbrough's read? A real-world case23:40 — FFR-CT, the ISCHEMIA trial, and why stenting asymptomatic patients is no longer standard of care25:25 — The future of cardiac imaging and the case for universal CCTA screening26:52 — The patient experience: what to expect at a CardiaVision CCTA appointment28:18 — Why seeing soft plaque changes patient behavior — the power of treating disease, not numbers29:49 — Bridging the gap between longevity medicine and traditional cardiology33:11 — Testosterone, the TRAVERSE trial, and what you should know about your coronaries first35:41 — What causes coronary artery disease beyond cholesterol: sugar, inflammation, gum disease37:07 — Image walkthrough: soft plaque vs. calcified plaque on a real CCTA41:36 — Where to find Dr. Brockenbrough and CardiaVision