WITHOUT SKIPPING A BEAT CHANCE TO AVOID SURGERY DOES THE HEART GOOD.

Byline: Marilee Reyes Staff Writer

It's a mouthful to say, but ``enhanced external counterpulsation'' (EECP) is giving people with failing hearts a new lease on life.

Joe Bryant, a retired land surveyor, could barely walk up stairs to go to bed without experiencing chest pain. Halfway through his treatment at the Cardiac Renewal Center in Encino, he was walking two miles a day and, more importantly, back on the golf links.

``These guys (doctors) can tell you how it works. I can tell you how it feels,'' said Bryant, 66, who lives in Northridge. ``It's given me my life back, and it's given my wife her life back.''

Stories like Bryant's are becoming increasingly more common, say officials from the Cardiac Renewal Center, which is opening branches throughout the state.

Pasadena resident Leigh Grapenthien, 63, could barely walk to his mailbox in January of last year without experiencing terrible angina. After seven weeks of treatment at Cardiac Renewal Center in Pasadena, he toured Germany, and EPCOT Center in Florida, and he now walks up to a mile a day with no pain.

On this day, his arthritis is bothering him. But he's only mentioning it, not complaining, mind you. Especially not after Dr. Harold Karpman, director of the center, reminds him ``that's one of the 'problems' with the therapy. People live longer and are more apt to encounter 'old man arthritis.' ''

``In that case,'' said Grapenthien with a smile, ``I won't complain.''

Before Grapenthien started the series of treatments, he wouldn't even have attempted to walk a block. After the 35 hours of treatment over a span of seven weeks, he could handle the walking that the trips entailed without apprehension or pain. He made the most of seeing the sights - including a professional football game while in Florida. But the best part of the trip is that he got around under his own steam. ``I can walk a mile, now, with no ill effects,'' he said.

Bryant had undergone open-heart surgical procedures in 1983, 1994 and 1997. When he started experiencing angina again, doctors told him there was too much scar tissue for him to go through additional surgery.

According to Karpman, the procedure can help heart patients avoid surgery, and can even be successful for patients who have already had surgery, like Grapenthien, whose heart health problems have had him in and out of hospitals since 1978. Among those previous treatments was a 10-day stay for quadruple bypass surgery, seven angiograms, a double angioplasty, hypertension and myocardial infarction.

He is still on several medications (Cardizem CD, Accupril and Lipitor daily, and a few others, as needed) but the success of the EECP treatment has renewed his enthusiasm for life and his ability to enjoy it.

Karpman says Grapenthien's experience is typical. The treatment is noninvasive and painless, and if necessary, can be repeated later. While it doesn't always completely eliminate angina pectoris, it almost always reduces and relieves the episodes.

Essentially, said Karpman, angina pain results when the heart muscle is not receiving an adequate supply of blood and oxygen. Muscle tissue can die. As the heart struggles to work, especially in situations of physical exertion and stress, the heart signals its distress with pain and chest pressure; pain often radiates down the arm. This condition can be life- threatening, and is definitely life-inhibiting.

Fortunately, the body often can increase the amount of blood flowing to an area by opening up the tiny blood vessels in nearby branches of the circulatory system. This process, a natural physiological response known as ``collateral circulation,'' allows the blood to detour around the blocked or restricted arteries.

The development of this collateral circulation in the heart muscle is what occurs during the EECP procedure. It is a gradual process, and while not everyone's physical condition allows this natural ability to develop these new networks, the success rate is high enough that people like Grapenthien and Bryant feel they have been given back their lives.

For one hour a day, five days a week over a seven-week period, patients are strapped into pressurized pants while they lie on a table and are told to do everything possible to relax. Cell phones and pagers go into a closet, the lights are dimmed, and the patients can listen to soft music, but no TV.

``They're here for a long time and we don't want them to dread coming here,'' said Rebecca Katt, director of operations at Encino's Cardiac Renewal Center.

Cardiac Renewal Center officials are in constant consultation with a patient's doctor, and the EECP sessions also monitor weight loss, exercise patterns and medication, said Katt.

The results of the procedure last up to five years, and 60 percent to 80 percent of those undergoing the program show marked improvement, said Karpman. The procedure is has been steadily gaining popularity, especially since Medicare agreed to pay for it in January of last year.

A pilot study has shown encouraging results for the use of EECP for treatment of such conditions as diabetes and Parkinson's disease. UCLA Medical School will be participating in a multicenter study to investigate EECP treatment on patients with congestive heart failure, said Encino CRC's Dr. Franklin Murphy, a clinical professor of medicine at UCLA. Those who have experienced angina finds that it restricts activities in every aspect of their lives. After EECP, nearly everyone reports being able to walk farther, carry heavier packages and lead a more active life, as Grapenthien discovered.

Grapenthien said of his own experience, ``It's like a miracle.''

Staff Writer Evan Henerson contributed to this report.

All about EECP

State University of New York at Stony Brook began clinical studies of EECP in 1989, and until the summer of 1995, the therapy was only available to participants in clinical studies. The procedure was approved by the FDA in 1995, but because of the expense of the equipment and an emphasis on research, it was still mostly located in academic settings.

Within the last two years, Cardiac Renewal Centers of America has made the treatment more readily available to heart patients. Eight treatment centers are located in Southern California, with two more scheduled to be open by February. Medicare and most insurance companies approve and accept EECP treatment.

Explained in very simple terms, the computerized EECP system encourages the opening or formation of small branches of blood vessels by applying external pressure to the lower extremities, thus stimulating the development of a natural bypass around blocked or narrowed arteries in the heart. The treatment is accomplished with three compression/decompression cuffs that wrap around the legs while the patient is lying down.

Under the application of a trained therapist who is in attendance during the entire treatment, the patient is hooked to an electrocardiograph (EKG) monitoring system that times the natural diastolic and systolic beating of the heart. In sequence with the signals from the patient's heartbeat, the cuffs inflate from the calves, through the lower thighs to the upper thighs and buttocks, moving blood along to raise diastolic aortic pressure.

The compression of the veins in the legs also increases venous return blood flow, easing an increased cardiac output by as much as 64 percent. The rapid and simultaneous decompression of the cuffs at the onset of the systolic beat produces a significant unloading of blood while decreasing the workload on the heart.

Basically, what occurs is that the increased blood flow allows the coronary collateral flow to increase in the ischemic regions of the myocardium (the middle layer of the heart wall). This provides oxygen and nutrients to the area, at the same time reducing oxygen demand because the pulsations of the cuffs are helping do the heart's work.

The treatment usually takes about one or two hours daily, five days a week for a total of 35 hours. In a successful treatment, this increased blood flow is permanent and continues after treatment has ended. Each person is different. Some individuals may require a longer or shorter period of treatment, and some may need to repeat the treatment at a later time.

Some health considerations preclude EECP treatment, including atrial fibrillation, atrial flutter or ventricular tachycardia, which can interfere with the triggering of the EECP system, bleeding problems and severe hypertension. After a complete medical history and physical examination, a patient's physician makes the decision to refer the individual for the treatment.

Individuals who may be candidates for EECP can visit a center for an evaluation and demonstration. Centers are in Pasadena, West Los Angeles, Glendale, Encino, Anaheim, Laguna Hills, San Diego, Oceanside and Ventura. For information, call [phone] or visit the Web site at www.CardiacRenewal.com or e-mail to HeartTrtmnt(at)cs.com.

- M.R.

CAPTION(S):

3 photos, box

Photo:

(1 -- cover -- color) Nonsurgical treatment improving quality of life for cardiac patients

(2) Joe Bryant, 66, undergoes enhanced external counterpulsation therapy, a nonsurgical procedure, at the Cardiac Renewal Center in Tarzana, while cardiac therapist Chris Jourat monitors Bryant's heart rate.

Charlotte Schmid-Maybach/Staff Photographer

(3) no caption (compression/decompression cuffs that wrap around the legs)

Box: All about EECP (see text)