AI Heart Scans: How CCTA with Cleerly and HeartFlow Detects Silent Heart Disease

Heart disease remains the leading cause of death in the United States, killing one American every 33 seconds. What makes this statistic particularly frustrating is that the first symptom of coronary artery disease is, for many people, a heart attack or sudden death.

Over the past decade, advances in cardiac imaging—particularly coronary computed tomography angiography (CCTA) enhanced by artificial intelligence—have made it possible to detect dangerous arterial plaque years or even decades before it causes symptoms.

If you've had a routine physical recently, your doctor probably ordered a lipid panel and possibly an EKG. A standard lipid panel explains only about 50% of cardiovascular events. Half of all heart attacks occur in people with "normal" cholesterol.

An EKG shows the heart's electrical activity, not its plumbing. A stress test only detects blockages already severe enough to limit blood flow during exercise—typically 70% or greater narrowing.

A coronary computed tomography angiography (CCTA) is a non-invasive scan that creates detailed, three-dimensional images of the coronary arteries without threading a catheter through your arteries. CCTA images reveal plaque buildup, degree of stenosis, plaque composition, and anatomical variants.

Cleerly is an AI platform that analyzes CCTA images to provide detailed characterization of coronary artery plaque. Rather than simply measuring narrowing, Cleerly quantifies the volume and composition of plaque throughout your coronary tree.

Cardiologists have long known that plaques most likely to rupture are often not the largest ones—they're the ones with specific structural features like low-attenuation plaque, positive remodeling, and spotty calcification.

HeartFlow uses the same CCTA images to create a computational model of the coronary arteries and simulate blood flow, outputting FFR-CT (fractional flow reserve derived from CT)—traditionally requiring invasive catheterization.

Anatomy doesn't always predict function. A 60% blockage in one patient might cause significant flow limitation; the same narrowing in another might not. HeartFlow removes the guesswork.

Cleerly is most valuable for patients with risk factors but no known coronary artery disease, those with borderline calcium scores needing more granular plaque information, and serial monitoring to track plaque progression over time.

HeartFlow is most valuable for patients with known blockages where the clinical question is whether to intervene, those with symptoms and moderate stenosis on imaging, and avoiding unnecessary invasive angiograms.

A 58-year-old member came for his annual evaluation appearing healthy by conventional standards. A CCTA with Cleerly analysis revealed a high-grade stenosis in his left anterior descending artery—the "widow-maker"—with predominantly non-calcified, rupture-prone plaque. He underwent successful stent placement.

Based on current evidence, men should consider a baseline CCTA starting around age 40, and women around age 50. Earlier screening is recommended with family history of early heart disease, elevated Lp(a), prediabetes, or prior calcium score showing plaque.

If your initial CCTA is normal, repeat imaging every 3–5 years is typically sufficient. If disease is detected, more frequent monitoring with aggressive risk factor modification may be appropriate.

Advanced cardiac lab work should include complete lipid panel analysis, ApoB, lipoprotein(a), inflammatory markers, homocysteine, and insulin resistance markers to understand why disease develops.

Traditional screening misses early disease. CCTA shows what's actually in your arteries. AI makes CCTA more powerful. Screening should start earlier than most people think, and a zero calcium score doesn't rule out dangerous soft plaque.