Taking a deep look into your heart


New three-dimensional technology is giving Mercy Regional Medical Center’s medical teams a better look at possible blockages in arteries. Derek Godberson, a registered cardiovascular invasive specialist, works the image as Dr. Alexander Fraley, left, and Karen Faul, a radiologic technologist and registered cardiovascular invasive specialist, watch and analyze.

By Dale Rodebaugh Herald staff writer

Cardiologists at Mercy Regional Medical Center recently acquired a new, improved version of technology used as backup for the angiogram, the old standby to locate blockages in arteries, veins or heart chamber.

“The angiogram is adequate for most people,” Dr. Alex Fraley, an interventional cardiologist, said in an interview about the new approach. “But there are times when we aren’t sure if a blockage requires further investigation.”

In those cases, Fraley said, cardiologists turn to a piece of equipment that combines ultrasound imaging and measurement of blood pressure across the blockage, providing a real-time look at a vessel or an organ.

Intravascular ultrasound imaging, known as IVUS, and fractional flow reserve, or FFR, offer a three-dimensional view of the inside of a vessel, going the two-dimensional angiogram one better.

The two technologies were housed in separate consoles but are now bundled in one, making it easier to use and more accurate, said Fraley, who asked for the improved technology when he arrived at Mercy last summer.

“We had a loaner,” Fraley said. “But our own arrived early this year.”

The two-in-one unit is more compatible with systems for image storing and sharing, Fraley said. The unit also has more applications, such as being able to be used in bigger vessels.

The $122,500 instrument was contributed by the Mercy Health Foundation through donations.

Every year, Mercy’s capital committee gets requests about department needs, said Karen Midkiff, the hospital’s chief development officer, a committee member. The CEO and the board choose from a priorities list.

The foundation looks for funding sources, including donors who have expressed an interest in a certain area, Midkiff said last week.

An angiogram is done by X-raying a vessel into which a dye that blocks radiation is injected. The contrast in image colors indicates the blockage.

“The angiogram sees only the lumen (the inside of the vessel),” Fraley said. “The IVUS visualizes the tissue of the vessel beyond the lumen.”

A 20 percent drop in blood pressure when the FFR is used indicates a significant blockage, Fraley said.

The IVUS-FFR system is guided into place by a catheter inserted in the groin or wrist. The information it provides on location and extent of blockage and blood pressure through the constricted area tells cardiologists where to place a stent and what size stent to use.

About 30 percent of angiogram patients are candidates for IVUS-FFR investigation, Fraley said.

“If a stent seems a reasonable solution, we use the IVUS or FFR,” Fraley said. “We don’t always use both IVUS and FFR in all cases.”

“We had first-generation versions of the IVUS and FFR at Mercy, but they were underutilized because they were difficult to set up and were less accurate,” Fraley said.

The technologies came into common usage about 10 years ago.

Fraley joined Mercy Cardiology Associates in August 2012. He has a degree in political economy of industrial societies at the University of California, Berkeley. He attended medical school at the University of Utah and did specialized studies at the University of California, San Diego, the William Beaumont Hospital in Royal Oak, Mich., and El Camino Hospital in Mountain View, Calif.

Mercy Cardiology Associates is operated by the Centura Health Physician Group and is located in the Mercy Medical Plaza.

Fraley said the IVUS and FFR technologies help doctors be more selective when it comes to interventions versus medical treatment. Studies have shown that angiograms have limits in diagnosing a patient and, in select patients, can result in under- and overtreatment with coronary stents.

“The new IVUS-FFR system is an evolutionary tool that we use in addition to angiography,” Fraley said. “The addition of higher fidelity imaging and increased physiological data support us as providers in tailoring treatment for the individual patient.”


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