Heart test is quick but controversial

High-tech scanner that detects calcium in arteries is debated among cardiologists

February 5, 2000

FLINT -- Donald Peters happily agreed to undergo a quick heart test that required no needle sticks and allowed him to stay fully dressed.

Flat on his back, he held his breath for 15 seconds as a sophisticated scanning machine quietly snapped three dozen views of his heart. Each X-ray scan is produced in as little as one-twentieth of a second -- much faster than conventional computerized tomography, or CT scans.

Five minutes later, Peters, 53, of Flushing, was elated to hear he had no evidence of calcium in his arteries. "Hallelujah," he said to Dr. Lily Lim, chief radiologist of Michigan Heart Imaging, an affiliate of McLaren Health Care Corporation. The imaging center, a half-mile uphill from McLaren Hospital, recently installed Michigan's first electron beam computerized tomography, or EBCT machine. Others are coming, including one the University of Michigan Medical Center plans to open in Southfield in July.

Across the country, the $1.8-million heart scanners are generating both excitement and discussion among consumers, and controversy among cardiologists, hospital administrators and insurers. Many insurers do not cover the $475 test, or pay for it fully, because they aren't sure it's worth the price tag. For now, many consumers pay for the test themselves, though some say they may seek insurance reimbursement. The test, growing in use as more clinics buy the machines, is recommended by proponents for men over 35 and women over 45 who are at risk of heart disease because of family history, high blood pressure or cholesterol, diabetes, obesity and other factors.

Doctors debate its worth

Calcium is a particularly good predictor of vulnerable plaque likely to rupture and cause a heart attack, said Dr. Anthony DeFranco, medical director of McLaren's Heart and Vascular Center. The more there is, the more likely there's a serious problem. "It's like saying, the more gray hair you have, the more likely you are to have wrinkles," DeFranco said. Consumers love the tool, he added, because it provides a clear warning even when people have no symptoms.

Unlike the good calcium people swallow in tablets and eat in food that builds bones, deposits of it in heart arteries are bad news. They indicate that plaque is sticking to artery walls, impeding blood flow.

Still, not all blockages have calcium deposits, said Dr. William O'Neill, chief of cardiology at Beaumont Hospital, Royal Oak. He believes EBCT is one of many diagnostic tools, but is not a proponent, saying it won't save lives and may lead to unnecessary tests, drugs and other medical interventions.

In cardiology circles, there is a heated debate about the machine. It will culminate in June when the American Heart Association and the American College of Cardiology expect to jointly issue consensus guidelines on EBCT.

Early reports say the guidelines will be mildly negative. The criticism, some say, was a reaction to aggressive advertising pitches from as many as 10 centers performing EBCT in Chicago.

Dr. John Rumberger, an Ohio State University cardiologist who has used EBCT for 17 years on more than 10,000 patients, resigned recently from the AHA-ACC consensus report committee because of the heavy-duty politics, he said. "You think Al Gore and George Bush have politics? Well, that's child's play compared to this. The science stands behind what we have found."

Dr. Robert O'Rourke, a San Antonio cardiologist who chairs the consensus report committee, said the Jan. 25 issue of Circulation, the AHA's journal, gives a good glimpse of the consensus report's findings. The Prevention Conference V report, as it is called, concludes that good scientific data are sparse, making it hard to properly recommend EBCT for the identification of high-risk patients who might need drugs and lifestyle modifications to prevent heart disease.

"I can't say anything more," said O'Rourke. "I've gotten hate mail." With top leaders in the field divided, consumers will be stuck sorting out the debate for many months.

Sifting out high-risk patients

"We will end up with thousands of more catheterizations based on needless scanning tests, and you can quote me on that," O'Neill predicts. Others disagree. "If I could sit him down in a room for an hour, I'd convince him," said Rumberger of O'Neill.

Dr. Melvyn Rubenfire, director of preventive cardiology at the University of Michigan Medical Center, said EBCT has its greatest value in two areas: identifying high-risk patients without symptoms and sorting out which patients who come to emergency departments with chest pain actually have had a heart attack. He soon plans to publish a review study of EBCT. The test "is very predictive. Once you have calcium you can't ignore it."

Diabetic patients also tend to have more calcium, and benefit from the tests, Rubenfire said. He is part of a U-M group that will team up with investors to open a heart imaging center with an EBCT machine in Southfield by July. They picked Southfield because of its multicultural population, among which EBCT remains largely untested, he said.

Patients who find they have elevated calcium levels need to follow up the findings with their physicians to determine the best way to lower their risks of heart disease. Some may undergo treadmill stress tests. In the test, people ride a stationary bike or walk on a treadmill, at increasing rates, to measure how their arteries respond to increased blood flow from exercise. If arteries can't meet the demand because of blockages, people don't get enough oxygen and experience chest pain.

In Flint, during the first two weeks of EBCT tests, patients responded with gratitude.

Fred Downs, 50, of Flint, president of a medical service corporation in Flint, said the heart scan's findings of moderate amounts of calcium was a wake-up call. He said he is changing his diet, has stopped smoking, and is exercising three times a week.

Betty Johnson, 71, of Flint, was relieved. She lives with high blood pressure and cholesterol, and had such side effects from cholesterol-lowering medicine that "I couldn't lift my feet." Her EBCT test showed no calcium. "I don't want to be on medicine if I don't have to," she said. A walker, she still plans to stay healthy. And she's telling her friends about the test.

These Web sites have more information: www.michiganheartimaging.com and www.imatron.com.

• To obtain a copy of the AHA report, call 800-242-8721 anytime or write the American Heart Association, Public Information, 7272 Greenville Ave., Dallas, TX 75231-4596.
• To reach Michigan Heart Imaging, call 877-642-4478 or 810-733-6182 anytime.

PATRICIA ANSTETT can be reached at 313-222-5021 or anstett@freepress.com.

All content ⓒ copyright 2000 Detroit Free Press and may not be republished without permission.