Small ultrasound scanners used spot artery plaque

MADISON, Wis. -- 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 sick bay 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.

Joan Anderson, center, a nurse practitioner, received training in using an ultrasound scanner Sept. 14 in Madison, Wis. The equipment is used by medical professionals to check whether a patient has heart disease, which might be detected in neck arteries. (Andy Manis ~ Associated Press)

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.

'Peace of mind'

Lisa Rosenstock of Madison, Wis., is an example. At age 41, this trim, athletic mother 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.

Risk and reward

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.

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."