Heart scans get cheaper, better and controversial

The scans can largely replace angiograms, the expensive, onerous way of looking for blockages in arteries, and can make diagnosis so easy that doctors would not hesitate to use them.They are expected to cost about $700, as compared to about $4,000 for a diagnostic angiogram. They take seconds and require no recuperation time; whereas angiograms take nearly an hour and patients have to stay in the hospital for a day. The new scans can see not just the outline of the blood vessels but every detail inside and out.

But, critics say, the situation is ripe for overuse, with doctors scanning people who do not need to be scanned and finding, and fixing, medical problems that do not need to be fixed. It is, medical experts agree, an extraordinary time in cardiology. Depending on which way the scanning market goes, the nation could save a fortune on diagnostic tests, and medical care could be improved. Or expenses could soar and patients could be harmed. The question is, how, if at all, can the technology be controlled?

With the new scans, most patients with chest pains or other symptoms will no longer need angiograms to see whether a coronary artery is narrowed or blocked by atherosclerosis.

Yet some heart experts say they see trouble ahead.For example, the scans identify narrowed coronary arteries in people with no symptoms of heart disease, like chest pains. Once a narrowing is found, many doctors and most patients want to fix it, putting in a stent or doing bypass surgery, even though, research shows, that will not prevent heart attacks in such patients, or save lives.

Patients might think such a procedure reasonable, just in case, but in fact ‘‘you have a lot to lose,’ said Dr. Geoffrey Rubin, the chief of cardiovascular imaging at Stanford University Medical Center. ‘‘All these procedures are risky,’’ and with no demonstrated benefit, there is no justification for the risk, he said.

Yet researchers say the new heart scans also hold immense promise. ‘‘This is a technology that has the potential to revolutionise the way we practice cardiology in this country,’’ said Dr. Joao Lima, director of cardiovascular imaging at Johns Hopkins.

Garcia gives a simple example: Most people who come to an emergency room with chest pains have a pulled muscle and are not having a heart attack. Yet many are admitted and observed for 24 hours. ‘‘That’s very expensive,’’ he says. ‘‘You have to do blood tests and monitor the heart for a day and maybe do a stress test before they let you go home.’’ If the tests look suspicious, the patient is sent for an angiogram.

But, Garcia said, ‘‘this CT machine in an emergency room could take a picture and very quickly tell you,’’ whether the pain is from a blocked artery, or not. He added: ‘‘That’s a phenomenal potential. I am convinced it will change the practice of medicine.’’