Newspaper Page Text
Little-known heart out chest
By Robyn Shelton (KRT)
The Orlando Sentinel
ORLANDO, Fla. —
Doctors have cut into
Theodore Dippy’s heart twice
to clear clogged arteries.
Other times, they swept
aside blockages with tiny bal¬
loons and once left a metal
stent inside an artery to keep it
propped open.
After going through the
most common heart proce¬
dures available, he finally
found relief with a little
known treatment that involves
squeezing the legs in large
cuffs to propel more blood to
the heart.
The nonsurgical approach,
called Enhanced External
Counterpulsation, is viewed
with disdain by some cardiolo¬
gists who question its value
because researchers can’t say
exactly how it helps the heart.
But studies have found that
most patients who undergo the
treatment have a significant
reduction in the chest pain that
otherwise might keep them
from walking up a flight of
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stairs or even across the front
yard.
a I would say about three
quarters of patients get some
benefit from it,” says Dr.
Andrew Michaels, who has
been involved in research on
the technique at the University
of California at San Francisco.
Most patients can exercise
further and have improved
quality of life.
On the negative side, we
still don’t have a clear under¬
standing of why it works.
The low-tech treatment is
carried out during one-hour
sessions while the patient lies
on a padded table with three
large cuffs on’each leg —
positioned on the calves, lower
thighs and upper thighs.
The cuffs squeeze sequen¬
tially up the leg with enough
force to jerk the person
upward slightly. They only
inflate when the heart is not
beating, in the moment of rest
between each contraction. This
is why the treatment is called
tt counterpulsation.
Patients typically undergo
35 sessions spread across
seven weeks, with five treat¬
ments per week. And some
people require more sessions
before they see improvement.
Dippy, 80, says he needs 45
sessions to get relief from his
chest pain, or angina, which
afflicts an estimated 6.4 mil¬
lion Americans.
He has gone through seven
courses of the treatment since
1999. No longer a candidate
for surgical procedures, Dippy
says he relies on the therapy to
keep his heart from further
deterioration.
Whenever my angina
starts to get worse, I go in for
another dose,” Dippy says.
I’ve gotten to the point where
I am pretty familiar with my
heart. I know when it needs
it.
Dippy’s doctor, cardiolo¬
gist Ken Kronhaus, has treated
more than 600 patients with
Enhanced External Counter
pulsation, called EECP for
short.
Kronhaus says the therapy
dates back to the 1950s, when
doctors at Harvard University
began experimenting with a
water-powered machine to
increase pressure on the legs
and drive more blood toward
the heart. It wasn’t successful.
All this big, hydraulic
device did was crimp and
crush the legs, and they kind
of gave up on it,” Kronhaus
says.
Decades later, in the 1980s,
scientists in both the United
States and China began tinker
ing with the approach again,
But it was the Chinese who
really ran with it, refining the
technology and using it exten
sively to treat patients in the
1990s.
In the United States, inter
est grew in the idea after trials
began to show potential bene
fits.
One 1999 study of 5,000
patients worldwide found that
73 percent of those treated had
a significant reduction in their
angina. What’s more, the
patients still were enjoying the
improvements two years later.
Today, doctors throughout
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Top photo, George Sken, Orlando Sentinel/Bottom photo, Stephen M. Dowell
Above, Cardiologist Ken Kronhaus in Mount Dora, Fla., checks on patient Judy
Ewing during treatment for heart disease. A nonsurgical approach, where patients lie
on a padded table with three large cuffs on each leg which are then squeezed
sequentially, inflating when the heart is not beating. Bottom photo, Ted Dippy, 80, a
retired pediatrician, is shown at his Astatula, Fla., home. Doctors have cut into
Dippy's heart twice to clear clogged arteries,
Florida offer the treatments,
and prestigious medical cen
ters, including the Mayo Clinic
and the Cleveland Clinic, have
centers for the procedure,
But the underlying ques¬
tion remains: How does the
procedure benefit the heart?
Kronhaus says doctors
think the rush of blood from
the lower body stimulates hor
mones and helps create new,
tiny vessels in the heart that
improve blood flow,
“We all have these hor¬
mones, but what this proce
dure does is enhance the flow
back to the heart, increasing
the concentration of hormones
and stimulating new vessel
growth,” he says. “It’s like
growing new branches on the
trunk of a tree,
Researchers have been able
to document the improved
blood flow by doing heart
scans on patients before and
after treatment to look for
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changes. Kronhaus says the
procedure can nurture new
vessel development up to six
months after the sessions end.
Despite growing accept¬
ance, the procedure remains a
last-resort treatment, only after
surgery or other invasive pro¬
cedures have been deemed too
risky.
Medicare began paying for
the procedure in 1999, but only
when it’s used on severe angi¬
na patients who have no other
options. Other insurers also
cover the procedure, which can
cost $5,000 to $7,000, for
patients in this category.
Kronhaus thinks the therapy's
image as a last resort keeps it
from being used more widely.
Many doctors, even cardi¬
ologists, still have not heard of
the treatment.
a I think the main reason
stems from a lack of a clear
mechanism of benefit,” says
Michaels, who has worked as a
PAGE 15A
consultant for the company
that makes the technology for
the procedure, Vasomedical.
“It’s hard for people to under¬
stand why squeezing the legs
for 35 hours would reduce
angina over the long term.
The American College of
Cardiology and the American
Heart Association, which
jointly issue treatment guide¬
lines for doctors, gave the pro¬
cedure a lukewarm rating in
2002, saying its usefulness and
efficacy are not well-estab¬
lished.
But more studies have been
finished in recent years, includ¬
ing one just released in March
that showed the treatment also
can benefit patients with con¬
gestive heart failure. Those
who were treated increased
their exercise time on a tread¬
mill by about 25 seconds,
while time decreased by about
13 seconds in a similar group
of patients who did not under¬