AI Heart Scans: How CCTA with Cleerly and HeartFlow Detects Silent Heart Disease
A physician's guide to advanced cardiac imaging, and why waiting for symptoms is no longer an acceptable strategy.
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. By the time you feel something, the damage is often done.
This doesn't have to be the case. 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. At Griffin Concierge Medical in Tampa and St. Petersburg, we've made these technologies central to how we practice preventive cardiology.
This article explains how AI-powered cardiac imaging works, compares the two leading platforms (Cleerly and HeartFlow), and outlines who should consider screening, even if they feel perfectly healthy.
The Problem with Traditional Cardiac Screening
If you've had a routine physical in the past few years, your doctor probably ordered a lipid panel and possibly an EKG. If you had concerning symptoms, they may have referred you for a stress test. These tools have been the backbone of cardiac risk assessment for decades.
The problem? They're not very good at catching early disease.
A standard lipid panel measures cholesterol, but cholesterol levels alone explain 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. And a stress test, while useful, only detects blockages that are already severe enough to limit blood flow during exercise, typically 70% or greater narrowing.
Consider what this means in practice: a patient could have a 50% blockage composed of unstable, rupture-prone plaque, exactly the kind that causes sudden heart attacks, and a stress test would come back completely normal.
"Disease touches every life — if not today, then eventually. With heart disease, the first symptom is too often the last. I assume risk until it’s proven otherwise because assumptions can cost lives. Taking a closer look can save one."
Dr. Radley Griffin, Griffin Concierge MedicalWhat a CCTA Actually Shows
A coronary computed tomography angiography (CCTA) is a non-invasive scan that creates detailed, three-dimensional images of the coronary arteries, the vessels that supply blood to the heart muscle. Unlike a traditional angiogram, which requires threading a catheter through your arteries, a CCTA is performed with a CT scanner. You receive a small amount of contrast dye through an IV, and the scan itself takes about 10-15 minutes.
The images reveal:
- Plaque buildup, including early-stage disease that hasn't yet caused narrowing
- The degree of stenosis, or how much the artery has narrowed
- Plaque composition, whether the buildup is calcified (stable) or soft (potentially unstable)
- Anatomical variants, abnormalities in how the coronary arteries are structured
This is valuable information on its own. But when you add AI analysis, the diagnostic picture becomes dramatically more precise. And importantly, today's technology is safer than ever, helping doctors make better diagnoses with lower radiation exposure.
Cleerly: Mapping the Character of Your Plaque
Cleerly is an AI platform that analyzes CCTA images to provide a detailed characterization of coronary artery plaque. Rather than simply measuring how much an artery has narrowed, Cleerly quantifies the volume and composition of plaque throughout your coronary tree.
This matters because not all plaque is created equal. Cardiologists have long known that the plaques most likely to rupture and cause heart attacks are often not the largest ones. They're the ones with specific structural features:
- Low-attenuation plaque (LAP), or "soft" plaque with a lipid-rich core, associated with higher rupture risk
- Positive remodeling, outward expansion of the artery wall that can mask disease severity
- Spotty calcification, small calcium deposits within soft plaque
Cleerly's algorithms identify and quantify these features, producing a report that goes far beyond "you have a 40% blockage." Instead, you get a comprehensive map of your plaque burden, broken down by type and location, with comparisons to age-matched populations.
For patients in the early stages of coronary artery disease, or those with risk factors but no symptoms, this information is invaluable for guiding treatment decisions. It answers the question: What kind of disease do I have, and how aggressively should we treat it?
At Griffin Concierge Medical, we partner with leading institutions to give our members access to Cleerly's technology at preferred pricing.
HeartFlow: Measuring What Actually Matters, Blood Flow
While Cleerly focuses primarily on plaque morphology, HeartFlow takes a different approach. Using the same CCTA images, HeartFlow's algorithms create a computational model of your coronary arteries and simulate blood flow through them.
The output is a measurement called FFR-CT (fractional flow reserve derived from CT). FFR is the gold standard for determining whether a blockage is actually causing ischemia, or inadequate blood flow to the heart muscle. Traditionally, FFR required an invasive catheterization procedure. HeartFlow provides the same information non-invasively, from a CT scan you've already had.
This is clinically significant because anatomy doesn't always predict function. A 60% blockage in one patient might cause significant flow limitation; the same degree of narrowing in another patient, with better collateral circulation or different vessel geometry, might not. HeartFlow removes the guesswork.
Through our partnership with TrueScan, Griffin Concierge Medical members have access to HeartFlow analysis at preferred pricing.
Cleerly AI
Primarily Plaque CharacterizationAnalyzes the composition, volume, and distribution of coronary plaque. Identifies high-risk features like low-attenuation plaque and positive remodeling.
- Quantifies total plaque burden
- Categorizes plaque by type (calcified, fibrous, fatty)
- Compares your disease to age-matched norms
- Tracks changes over time with serial scans
HeartFlow FFR-CT
Primarily Flow DynamicsCreates a digital twin of your coronary arteries and simulates blood flow to determine if blockages are causing functional impairment.
- Calculates FFR without invasive catheterization
- Determines if a blockage needs intervention
- Helps avoid unnecessary stents and caths
- Provides vessel-specific flow analysis
Which Technology Is Right for You?
The choice between Cleerly and HeartFlow depends on your clinical situation. It's worth noting that both companies continue to expand their capabilities. Cleerly has begun measuring functional flow, and HeartFlow can assess plaque characteristics. But each platform has its primary strength:
Cleerly is often most valuable for:
- Patients with risk factors but no known coronary artery disease, to establish a baseline and guide prevention
- Those with borderline or moderate calcium scores who need more granular plaque information
- Serial monitoring to track whether aggressive treatment is stabilizing or reducing plaque over time
HeartFlow is often most valuable for:
- Patients with known blockages where the clinical question is whether to intervene
- Those with symptoms (chest pain, shortness of breath) and moderate stenosis on imaging
- Avoiding unnecessary invasive angiograms when functional significance is uncertain
In some cases, both analyses provide complementary information. We work with each patient to determine the most appropriate diagnostic pathway.
The Blockage Waiting to Be Found
A member in his 40s recently completed advanced cardiac imaging as part of his annual evaluation at Griffin Concierge Medical. He was fit and active, had never smoked, and his labs were unremarkable. He had no symptoms to report.
His CCTA scan with Cleerly analysis revealed significant stenosis in his left anterior descending artery, the vessel cardiologists refer to as the "widow-maker" because of its association with sudden cardiac death. The plaque was predominantly non-calcified, meaning it was soft, inflamed, and at risk of rupturing without warning.
Traditional screening would not have detected this. A stress test would have been normal. His cholesterol numbers gave no indication of the underlying disease. The only way to identify it was to look directly at his coronary arteries.
He is now working closely with his Griffin physician on targeted lifestyle modifications and evaluating options for medical intervention. The objective is to stabilize the plaque and, ideally, reverse its progression before it leads to a cardiac event.
Proactive screening allowed us to identify a serious condition while it was still manageable, rather than after a heart attack had already occurred.
When Should You Get a Baseline CCTA?
Based on current evidence and our clinical experience, here's who should consider screening:
Men: Consider a baseline CCTA starting around age 40.
Women: Consider a baseline CCTA starting around age 50.
Earlier screening (age 35-40) if you have:
- A parent or sibling who had a heart attack before age 55 (men) or 65 (women)
- Prediabetes, insulin resistance, or metabolic concerns
- Elevated Lp(a) on blood work (a genetic risk marker)
- A prior calcium score that showed any calcified plaque
If your initial CCTA is normal, repeat imaging every 3-5 years is typically sufficient. If disease is detected, more frequent monitoring, along with aggressive risk factor modification, may be appropriate.
Beyond Imaging: The Lab Work That Completes the Picture
A CCTA shows you the current state of your arteries. But to understand why disease developed, and how to stop its progression, you need the right blood tests.
At Griffin Concierge Medical, we go well beyond the standard lipid panel. Our advanced cardiac lab work includes:
- Complete lipid panel with pattern analysis: Beyond basic cholesterol, we look at the full picture. Low HDL cholesterol, especially when coupled with high triglycerides, is a powerful warning sign. If you see this pattern, assume plaque is present until proven otherwise.
- Apolipoprotein B (ApoB): A direct count of atherogenic particles. Research published in JAMA Cardiology has shown ApoB outperforms LDL cholesterol as a predictor of cardiovascular events.
- Lipoprotein(a): A genetically determined, highly inflammatory particle. Elevated Lp(a) dramatically increases heart attack and stroke risk and doesn't respond to lifestyle changes.
- Inflammatory markers: Including high-sensitivity CRP (hsCRP), uric acid, ferritin, and liver enzymes. Elevated levels indicate active systemic or vascular inflammation, even when cholesterol looks fine.
- Homocysteine: An amino acid linked to endothelial damage. Elevated levels are often correctable with targeted B-vitamin supplementation.
- Insulin and HOMA-IR: Markers of insulin resistance, which drives accelerated atherosclerosis even before diabetes develops.
Key Takeaways
- Traditional screening misses early disease. Stress tests only detect severe blockages; lipid panels miss half of cardiovascular events.
- CCTA shows what's actually in your arteries. It detects plaque years before symptoms develop.
- AI makes CCTA even more powerful. Cleerly primarily characterizes plaque composition; HeartFlow primarily measures functional significance. Both continue to expand their capabilities.
- Screening should start earlier than most people think. Men around 40, women around 50, earlier if you have risk factors.
- A zero calcium score isn't the full picture. Especially in younger patients, a zero score is expected and doesn't rule out soft, non-calcified plaque, the kind most likely to rupture.
- Imaging plus labs equals a complete picture. Advanced biomarkers explain why disease develops and guide treatment.
Frequently Asked Questions
A CCTA (Coronary Computed Tomography Angiography) is a non-invasive imaging test that uses CT technology to create detailed 3D images of your coronary arteries. Unlike a traditional angiogram, it doesn't require threading a catheter into your heart. The scan takes about 10-15 minutes and can detect plaque buildup, narrowing, and blockages in the arteries that supply blood to your heart muscle.
Cleerly primarily analyzes plaque composition, determining whether blockages are made of stable calcified plaque or dangerous soft plaque prone to rupture. HeartFlow primarily measures blood flow dynamics using computational fluid dynamics to determine if a blockage is actually restricting oxygen delivery to the heart. Cleerly answers "What kind of disease do I have?" while HeartFlow answers "Is this blockage causing functional impairment right now?" Both companies continue to expand their capabilities into each other's domains.
Griffin Concierge Medical recommends men consider a baseline CCTA around age 40 and women around age 50. However, individuals with elevated Lp(a), metabolic syndrome, strong family history of early heart disease, or multiple cardiovascular risk factors should consider screening earlier, sometimes in their 30s.
No. A stress test only detects blockages severe enough to limit blood flow during exercise, typically 70% or greater narrowing. Many heart attacks occur from the rupture of smaller, unstable plaques that wouldn't show up on a stress test. CCTA can detect these dangerous plaques before they cause symptoms or a cardiac event.
A standard CCTA typically costs $300-$600 at imaging centers. Cleerly AI analysis adds approximately $500-$900. HeartFlow analysis is similar. Many insurance plans cover CCTA when ordered for appropriate clinical indications. Griffin Concierge Medical members have access to preferred pricing through our imaging partnerships.
Modern CCTA scans deliver approximately 1-5 millisieverts of radiation, roughly equivalent to 6-24 months of natural background radiation. For comparison, a traditional cardiac catheterization delivers 5-15 mSv. The diagnostic benefit of detecting silent coronary disease generally outweighs the minimal radiation risk, especially for individuals with cardiovascular risk factors.
