Today, Pierre Clement is off morphine, out of his wheelchair and walking two miles every morning. What changed his life was not a heroic operation or a costly new drug but a pair of pressurized pants. Clement is one of 18 U.S. heart patients pioneering a treatment called enhanced external counterpulsation. Rather than having his arteries catheterized or surgically bypassed, he spent 36 hour-long sessions strapped into a garment that works like a giant, pulsating blood-pressure cuff, painlessly forcing blood from the legs and hips into the chest. No one knows precisely how the treatment works or how long the effects last. But researchers at the Health Sciences Center in Stony Brook, N.Y., have recently shown that it can succeed where more costly and invasive treatments fail. If larger trials confirm that finding, cardiology may never be the same.
Dr. Harry Soroff, a heart surgeon at Stony Brook, conceived the counterpulsation technique 30 years ago at Harvard. During the 1960s and ’70s, he and a collaborator designed various pulsating leg cuffs in attempts to force blood into the heart between beats. Unfortunately, their early devices lacked the power and precise timing the task demanded. Overshadowed by such flashy innovations as bypass surgery and balloon angioplasty (which uses a balloon-tipped catheter to reopen blocked arteries), counterpulsation fell into obscurity in the United States. In China, however, doctors kept honing the technique. In 1986, Soroff discovered that one researcher, Dr. Zhen Sheng Zheng, had developed a more sophisticated device, so he invited Zhen to set one up at Stony Brook. Two years ago, with Zhen’s help, Soroff and his colleagues started treating patients. The researchers are now reporting their first results.
The 18 patients in the Stony Brook study all suffered from chronic chest pain. Some had failed conventional treatment; others were unable to risk it. Yet all 18 enjoyed some improvement following seven weeks of counterpulsation, and 16 reported complete relief. “Many of these patients seemed beyond help,” says Dr. Peter Cohn, Stony Brook’s chief of cardiology and a collaborator on the study. “Here they are saying they feel fine.” Most of the patients improved by more rigorous measures as well. Thallium stress tests, which use radioactive dye to monitor actual blood flow within the heart, showed that 14 patients (78 percent) regained some heart function following treatment and that 12 (or 67 percent) returned to normal. Though the physiological mechanism remains something of a mystery, the researchers believe that by forcing blood into the chest, they’re creating or enlarging small, auxiliary blood vessels that provide a natural bypass around the diseased ones.
The researchers are now tracking the patients’ long-term progress and organizing larger trials. For the time being, they’re not touting counterpulsation as an alternative to surgery; “We’re still treating this as a last resort for people who have exhausted other therapies,” says Dr. William Lawson, the Stony Brook cardiologist who led the study. But the situation could change. American doctors perform some 400,000 bypass operations every year, at an average cost of $30,000. Half of all bypass grafts fail within 10 years-and no one has proven that even the most successful grafts do anything for people with mild heart disease. If future research shows that patients fare just as well on $5,000 worth of painless pressure-pants therapy, the bypass business could end up in well-deserved decline.
