HEART SMART? NEW SCANNER MAY DETECT CORONARY DISEASE EARLIER, BUT SOME CONTEND COST OUTWEIGHS ADVANTAGES.

Byline: Phil Davis Staff Writer

The blood in Lyn Garrison's coronary arteries flows around tiny calcium-rich bumps - an early sign that disease is slowly choking her heart.

While not good, the news is a wake-up call, not a death sentence.

There is still time to stop smoking, to lose weight and to cut back on the low-density lipoprotein (LDL) cholesterol that feeds the blockages.

``I'll be changing a lot of my habits, for sure,'' said Garrison, 54, a Simi Valley resident who works in the radiology department at Cedars-Sinai Medical Center. ``Being in the medical field, I know I should be eating low-fat foods and not smoking, and, of course, I do the opposite. But I think this will do it because you always think, `Not me.' ''

This cardiac wake-up call comes courtesy of a controversial machine called the Electron Beam Computed Tomography scanner, also known as the ``ultrafast'' CT. The $2 million machine snaps electronic images of calcium buildup inside the body faster than other imaging equipment, which makes it useful in scanning the heart. Calcium deposits are a sign of atherosclerosis, the buildup of plaque in arteries that can lead to heart attack or stroke.

The machine is currently at the center of a heated debate: Is the ability to pick up extremely early traces of heart disease medically useful, or is the ultrafast CT just an overpriced scare tactic with no real diagnostic value?

Supporters say the scanner is the best way to detect heart disease in its earliest, most curable stage. It can provide vivid, if not frightening, proof that a patient had better change his or her ways before the disease spreads.

``It's the difference between having risk factors for a disease and having a disease,'' said Dr. Daniel Berman, chief of cardiac imaging at Cedars-Sinai Medical Center. ``Tell a smoker that smoking causes lung cancer and they say, `Yeah, but most smokers don't get lung cancer.' Show them they have lung cancer in their chest X-ray, they stop smoking right away.

``The same thing happens with coronary disease,'' Berman continued. ``It goes in one ear and out the other when you tell people they have high cholesterol and they really should reduce it. Show them plaque in their coronary arteries and they go on medication and change their diet. It really does alter lifestyles.''

Critics say the ultrafast CT essentially proves what doctors already know, that a person of a certain age with specific medical problems is at increased risk of heart disease. They say the marketing of ultrafast CTs - which allows patients to schedule the scan without a referral from their physician - encourages unneccesary, expensive medical testing. They also worry a clean scan will encourage patients to continue the bad habits that put them at risk.

Dr. Robert Detrano, a cardiologist at Harbor-UCLA Medical Center and author of a 1996 American Journal of Cardiology study that questioned the value of the ultrafast CT, said the scan does seem to frighten some patients enough to ``at least say they're going to change.'' But he was disappointed with the machine.

``We haven't found that it predicts heart attacks very well,'' Detrano said. ``We see a lot of people with heart attacks who don't have calcium.''

His biggest problem with the procedure was the cost. He and some colleagues abandoned a more comprehensive study to measure the effectiveness of the ultrafast CT in stopping people from smoking because the procedure cost too much. The researchers determined the money was better spent counseling smokers or paying for medications to directly combat the problem.

Cedars-Sinai charges $395 for the scan, a cholesterol screening and consultation with a cardiologist. Anyone can take it, but Berman said it is most useful for men ages 35-55 and women ages 45-65 who have at least two heart disease risk factors. The risk factors are: high LDL cholesterol levels, diabetes, high blood pressure, smoking, obesity or a family history of early heart disease.

``The majority of the patients have abnormalities in their scan,'' Berman said. ``When they have no abnormality, we're careful to make sure they don't say, `Oh, I can go out and start smoking and having cheeseburgers.' We'll also be following that with research.''

Berman hopes to end any debate with the most comprehensive study of the ultrafast CT to date. In the coming months, he and his colleagues will be screening 10,000 Cedars-Sinai employees for heart disease risk factors. Those at highest risk of heart trouble will be broken into two groups: Both groups will be counseled and treated to ward off heart disease, but one group will also get an ultrafast CT. Researchers will follow the patients for five years to see if the scan has any impact on the way they care for their heart.

Will the patients be scared straight? No one can say for sure.

In other fields, the philosophy hasn't worked well.

``Scaring people is usually counterproductive,'' said Dr. Frank Grossman, a dentist in Glendale who often uses high-tech images of teeth to teach patients about gum disease and tooth decay. ``I think educating them without scaring them is a better approach.''

Grossman believes many of his patients leave the office with good intentions, but then slip back into old habits.

The same could be said of heart disease. Despite the fact that diseases of the heart kill nearly 1 million Americans each year, most people ignore the well-publicized risks. There is a wealth of information that high LDL cholesterol, smoking, obesity and a host of other lifestyle choices have a profound impact on whether a person will develop heart disease, the nation's No. 1 killer of both men and women.

According to the American Heart Association, roughly half of the 14 million Americans who have some form of coronary artery disease will find out about it only after they have a heart attack or irreversible damage.

For example, a treadmill stress test, another way to detect blocked arteries, is only effective after the blockage is more than 50 percent, Berman said.

He said the ultrafast CT can catch heart disease before the material obstructs any blood flow, giving physicians the ability to head off future problems.

``It's not just about making a diagnosis of something we can't treat. This is a disease that can be stopped,'' he said. ``It doesn't really matter if (the plaque) you've already got in there goes away. If you stop the progression of the disease, there's no reason you shouldn't be healthy, live to be 100 and have something else get you.''

But in the end, no matter what researchers say, the bottom line comes down to money for both hospitals and patients.

Detrano said the roughly 50 American centers that have an ultrafast CT are pushing calcium scanning to pay for the machines that can't do much else.

``If you buy one of these machines for $2 million, you're stuck with it,'' he said. ``It's not very good for scanning the abdomen, the head, the knees or the spine, so you're stuck with scanning the heart or screening for calcium. It's the only way you can make it pay for itself, and that's why all these people are doing it.''

And since most insurers don't cover the ultrafast CT scan, prospective patients also have to make a bottom-line assessment.

``It depends on how much money you've got in your pocket,'' Detrano said. ``If you've got a lot of money to be scared with, then it's fine. But I don't know if it's worth it for most people. That's the issue here.''

CAPTION(S):

3 Photos

Photo: (1 -- cover -- color) The price of insight

A new device can reveal your heart's health. But is the revelation worth the cost?

(2) The Electron Beam Computed Tomography scanner, also known as the ``ultrafast'' CT, is being used across the country as a means of detecting the early signs of heart disease.

(3) `It's the difference between having risk factors for a disease and having a disease.'

Dr. Daniel Berman

Chief of cardiac imaging at Cedars-Sinai Medical Center

Andy Holzman/Staff Photographer