Desmond Ebanks, M.D., of Alternity Healthcare, a preventive medical practice
Q. You have brought the SphygmoCor CP system, a new cardiovascular test, to your practice at Alternity Healthcare in West Hartford. What is it and why should people care about it?
A. The SphygmoCor CP system is a painless and non-invasive test that measures critical cardiovascular system parameters that are not available with traditional brachial blood pressure cuff measurements. The CP system allows the non-invasive measurement of the pressure that the heart, brain and kidneys actually experience. Through a complex algorithm, the pressure wave at the ascending aorta is derived from an external measurement of the patient's radial artery at the wrist. This identifies the central aortic pressure, determines the portion of the pressure attributable to diseased or stiffened arteries, the relative workload of the heart, and the ratio between the heart's demand for oxygen and the available supply.
These central blood pressure measurements have been shown to be a superior predictor of cardiovascular events. Traditional peripheral brachial blood pressure cuff measurements do not accurately reflect central pressures due to pressure amplification. And, medications have different effects on central blood pressure despite similar reductions in brachial blood pressure.
Incorporating this technology into the cutting edge cardiovascular screening already available at Alternity Healthcare helps me to correctly answer two questions for my patients: (1) Do I have cardiovascular disease that puts me at risk for a heart attack or stroke? (2) If so, what can I do about it?
Q. Is this procedure covered by insurance? How accurate is it? Have long-term results been done on it?
A. The SphygmoCor CP system is an FDA-approved device. Coverage varies with individual insurance policies and carriers. Unfortunately, despite much talk about preventive medicine and the benefits of catching disease at an early stage to reduce overall costs, our healthcare system, and health insurance system, is mostly reactive; focused on treatment of disease rather than prevention. Often people must pay out of pocket for some of the best screening tests to protect their health. There is a difference between the best care for an individual and cost effective care for a population. After all, who is it that suffers the consequences of an undetected disease? Not the insurer.
In clinical studies, it has been favorably compared to pressure measurements with a catheter inside the ascending aorta. The CP system measurements are within a negligible 0.7 mmHg of the internal catheter measurements.
The SphygmoCor CP system has been featured in hundreds of published studies and is used in leading medical centers worldwide, including the Mayo Clinic and Cleveland Clinic, and in pharmaceutical and device clinical trials.
Q. How long has this test been around and why is it now just coming to Greater Hartford? It seems as if a test of this nature might do better in a suburban environment without the vast medical services offered in a major urban center like New York or Boston.
A. Historically, central blood pressure measurements have been used to monitor and treat critically ill patients. It just wasn't practical to use for everyone because it required an invasive procedure to place a catheter into the heart or aorta. The SphygmoCor CP system uses noninvasive applanation tonometry to capture the central aortic pulse waveform. This technology was developed in 1988 and was FDA approved in 2002.
Change comes very slowly to medical practice. Medicine has developed a lot of conventions that become ingrained beliefs or modes of operation and in many instances continue unchanged even in the face of scientific advancements.
I do not follow your logic regarding location as a determinant of the value of this technology. If anything, this technology may be more available in an urban setting as it is already in use at leading medical centers, and the density of innovative medical practices is likely to be greater. Irrespective of location, measuring central blood pressure is crucial.
At the risk of sounding self-serving, this technology is coming to Greater Hartford now because I recognized its value in the context of my practice philosophy. A year ago I brought another cutting-edge technology to this area; the HeartSmart IMT plus. That CIMT test measures the thickness of the carotid intima media, the innermost layer of the carotid artery where atherosclerosis begins. I was the first physician in CT to make this available in a clinical setting.
Q. Your practice focuses on preventive medicine with what seems to be an emphasis on hormonal deficiencies and the silent inflammations associated with heart disease. Does your practice use traditional health care methods or does it embrace more homeopathic medical treatments?
A. I try to avoid labels, because people tend to have preconceived notions about what any particular label means. I am a conventionally trained, board-certified internist with nearly 25 years of experience treating patients. Over the years, I became increasing disenchanted with the direction of conventional medicine, the focus on elaborate and frequently toxic treatment rather than prevention and the growing gap between the science of medicine and the practice of medicine. Alternity Healthcare is an integrative blending of traditional western medicine with elements of holistic practice.
Prevention of chronic diseases and enhancing quality of life are the core tenets by which I practice. The latest scientific evidence clearly implicates chronic inflammation as a root cause of most chronic diseases, including heart disease, and influences the rate and manner in which we age. Much of the inflammatory response can be managed through appropriate lifestyle modifications. Similarly, hormonal imbalances, not necessarily deficiencies, directly influence the risk for chronic diseases, the expression of those diseases and the quality of life we enjoy. Typically, when hormones are mentioned, most think only about sex hormones; estrogen for women and testosterone for men, or the abuse of growth hormone by elite athletes. There is much more to hormones than that oversimplification. Hormones are the chemical messengers that facilitate communication between our various organ systems. It is the overall balance of our endocrine system that is a key to better health.