In this episode I sit down with Dr Campbell Rogers, an interventional cardiologist who trained at Harvard, ran the cardiac catheterisation lab at Brigham and Women’s Hospital, and now serves as Chief Medical Officer at Heartflow. The reason I wanted to speak with him is personal. In late 2024 I had a CT coronary angiogram that revealed a small amount of soft plaque in my arteries. Sixteen months later I had a second scan, and the results genuinely surprised me.
For most of medical history we have managed heart disease by treating numbers: cholesterol, blood pressure, and risk scores. We could rarely see the disease itself. AI-powered imaging is starting to change that, letting us measure exactly how much plaque a person has and what it is made of. That raises a fascinating, and slightly uncomfortable, question. If my plaque appears to have regressed by around forty percent in sixteen months, can I trust that result, or is it measurement noise dressed up as good news? Campbell and I work through the science, the uncertainty, and what it all means.
What we cover:
- Why two thirds of patients historically went through an invasive angiogram only to be told they were fine, and how non-invasive imaging is changing that
- The difference between a calcium score, a CT coronary angiogram, and AI plaque analysis, and why a calcium score of zero does not mean you are free of disease
- What my own scans actually showed, including a roughly forty percent drop in plaque volume and a small plaque in my left main artery that disappeared
- Why Campbell says he believes my result, and why that still does not mean everyone would respond the same way
- How soft, non-calcified plaque differs from calcified plaque, and why a rising calcium score after starting a statin can be a sign of stabilisation
- Whether we should be treating the plaque we can actually see rather than just chasing an ApoB number
- The risk of confirmation bias when three different tools disagree, and why prospective validation matters
- Who should consider getting scanned, and the honest trade-offs of radiation, cost, and uncertainty
This conversation sits right at the edge of what cardiology can currently measure, and I appreciated Campbell’s willingness to sit in the uncertainty with me rather than overstate the case. If you care about preventing the disease that still kills more people than any other, I think you will get a lot from it.
To connect with Dr Campbell Rogers, visit Heartflow.
- How Campbell Rogers went from cardiologist to Heartflow (00:00)
- What Heartflow is and how it works (07:26)
- Coronary CT angiogram vs. stress test (11:54)
- Why symptoms alone miss early heart disease (13:18)
- How Heartflow analyzes CT scans in 90 minutes (15:58)
- Calcified vs. non-calcified plaque: which is riskier (21:28)
- Why calcium score zero doesn’t mean no heart disease (28:45)
- Who should get a CT angiogram with AI plaque analysis (31:09)
- Why seeing your plaque improves medication adherence (34:04)
- Simon’s 2024 Heartflow scan results (39:12)
- How plaque rupture triggers a heart attack (43:25)
- Simon’s 2026 Heartflow scan: 40% plaque reduction in 16 months (45:43)
- How long to wait between CT scans (51:14)
- Heartflow vs. Cleerly vs. QAngio (53:12)
- How Heartflow results led Simon to start statins (58:21)
- JAMA study: Heartflow tracks plaque in prostate cancer patients (1:00:10)
- What is low attenuation plaque and why it’s high risk (1:02:53)
- Who should ask their doctor about a coronary CT angiogram (1:07:37)
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More about Campbell Rogers
Dr Campbell Rogers has worked in cardiovascular medicine for over 30 years, with leadership positions both in academic research and practice, and in medtech industry. Prior to joining Heartflow as Chief Medical Officer in 2012, Dr Rogers was Chief Scientific Officer and Global Head of Research and Development at Cordis Corporation, Johnson & Johnson. Prior to Cordis, he was Associate Professor of Medicine at Harvard Medical School and the Harvard-MIT Division of Health Sciences and Technology, and Director of the Cardiac Catheterization Laboratory at Brigham and Women’s Hospital leading its educational, clinical care, and research programs.
