Date:
10/05/2007 05:33 PM Coming to your doctor's office: Small ultrasound scanners
to spot hidden artery plaque
By MARILYNN MARCHIONE
AP Medical Writer
MADISON, Wis. (AP) _ What if your doctor could
swipe a wand over your neck and reveal whether you have hidden
heart disease?
That is now possible in places other than
the sickbay of the starship Enterprise.
Miniature ultrasound machines are starting
to make their way into ordinary doctors' offices, where they
may someday be as common as stethoscopes and EKGs. A pocket-sized
one weighing less than 2 pounds hit the market last week.
Some of these devices can make images of neck
arteries, which offer a "window" to heart arteries
that cannot easily be seen. If the neck vessels are clogged,
doctors know that those around the heart probably are, too,
and that treatment or more testing is needed.
The new ultrasound machines offer a relatively
cheap, painless way to screen people with no symptoms of heart
problems for signs of hidden trouble.
Is that a good thing?
Many doctors say yes, because for one-third
of heart disease sufferers, the first symptom is dropping
dead of a heart attack. Finding these people early and treating
them could save lives. The test may be especially good for
women, who often have few traditional signs.
Lisa Rosenstock of Madison, Wis., is an example.
At age 41, this trim, athletic mom had normal cholesterol
and blood pressure but a troubling family history of heart
attacks. Ultrasound revealed a big clog in the main artery
from her heart to her head.
Her cardiologist, Dr. James Stein of the University
of Wisconsin-Madison, put her on medicines to lower her risk
of a heart attack or stroke. He also is leading a study aimed
at making ultrasound testing more common.
"There's a great need for a noninvasive
and safe way to identify people who don't have signs but have
risk" of heart disease, he said.
But there are potential downsides to more
people doing this testing without extensive training. Suddenly,
small-town family doctors could see scary-looking artery buildups
and rush to treat some that might never be life-threatening.
And while patients who see the pictures may
be motivated to quit smoking, lose weight or go on cholesterol
drugs, some might suffer side effects from unnecessary treatment.
Ultrasounds also are being advertised directly
to consumers — the latest "peace of mind"
test like whole-body CT scans and MRIs. Some drugmakers are
promoting wider testing because it could boost cholesterol
pill sales.
The American Heart Association says testing
with traditional ultrasound machines can help certain patients,
but does not endorse widespread screening with the small devices
because proof of benefit is lacking.
Guidelines from several groups suggesting
who should use the small ultrasound devices, and on which
patients, are expected next spring, said Stein, who heads
a panel writing the advice.
On balance, many doctors see more promise
than peril.
"It's equivalent to a mammogram of the
heart," said Dr. Christopher Rembold, a cardiologist
at the University of Virginia. If doctors see something suspicious,
they can refer patients to specialists for more extensive
tests before deciding whether or how to treat it, he said.
Screening involves checking for buildups called
plaque and measuring the thickness of the wall of the main
neck artery. Normal thickness varies by age, race and sex,
and charts give doctors detailed guidance. Too-thick arteries
are a sign of higher risk for heart attack.
Until recently, only ultrasound specialists
did these tests, which were analyzed by a radiologist. That
often meant patients needed another appointment at a hospital
or ultrasound center, and a return trip to their primary doctor
for results.
The portable ultrasound devices are changing
that. SonoSite Inc. of Bothell, Wash., came out with one in
1999. It was followed by GE Healthcare, a suburban Milwaukee
unit of General Electric. They mostly are used in emergency
rooms to check for problems with the heart's valves or pumping
capacity, or bulging abdominal arteries threatening to rupture.
But scanning neck arteries became more common
after SonoSite's MicroMaxx came out in 2005. The 8-pound device
is a small laptop and costs $25,000, or about $40,000 with
related software.
The pocket-sized device that went on sale
last week — the $10,000 Acuson P10 — might eventually
expand artery scanning even more. Siemens Medical Solutions,
the Malvern, Pa.-based unit of the German company Siemens
AG, initially will sell the device for traditional heart imaging
and emergency use, but plans to offer artery imaging in the
near future. The quality of the images will have to be proved
for the device to gain wide acceptance, several experts said.
At UW-Madison, doctors have done neck scans
with portable ultrasounds on about 900 patients. They charge
$295, and three local HMOs agreed to pay. Most insurers do
not, because of limited proof of the value of such tests.
Others are selling neck scanning directly
to consumers.
Dr. Robert Bonow, cardiology chief at Northwestern
University and a past heart association president, recently
got an ad in the mail for screening at a shopping center near
his Glencoe, Ill., home. He worries about the accuracy of
such testing.
Suppose the scanning is 90 percent accurate,
and the normal rate of heart disease is 10 percent, he said.
That would mean 20 out of 200 people would have heart disease
and 180 would not. But the scan would tell 18 people they
had it when they didn't, and would miss heart disease in 18
who did.
Because of the false alarms, "you may
be treating twice as many people as you have to," he
said. "If you're dealing with 2 million people, that's
a lot of people who don't need treatment."
Robert Rosner, an ultrasound technician in
Fort Myers, Fla., sells screening to police, fire and other
municipal workers and through doctor offices and health clubs.
He charges $180 and offers a personal testimonial. At age
42, he scanned his own arteries and was surprised to see a
30 percent narrowing in one. A doctor put him on medications,
and a couple of years later, the plaque was gone.
"Without needles or radiation or pain
... there's disease in the body that can be reversed,"
he said. "I'm living proof."
UW's Stein is leading a study to see whether
family practice doctors can be trained in a weekend to accurately
do the tests. SonoSite donated equipment, and a university-administered
grant is paying for the study, which will test 350 patients.
"The danger of overtreating is low, especially
in an environment where we dangerously undertreat risk factors,"
Stein said. Screening itself can be good, he pointed out.
A previous study found that even those whose arteries were
found to be normal were motivated to exercise more.
It should do even more good for people who
do have heart disease, said Dr. Sanford Carimi, a Janesville,
Wis., physician participating in Stein's study.
"If I tell you your cholesterol is 130,
that won't bother you," he said. "If I show you
you have a plaque in the blood vessel leading to your brain,
you're more likely to make some changes."
