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External counterpulsation therapy improves endothelial function in patients with refractory angina pectoris
Michael Shechter1, Shlomi Matetzky, Micha S Feinberg
1Heart Institute, Chaim Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel. schectes@netvision.net.il
Journal of the American College of Cardiology
|December 19, 2003
Summary
Short-term external counterpulsation (ECP) therapy significantly improved vascular endothelial function, measured by flow-mediated dilation (FMD), in patients with coronary artery disease (CAD). This enhancement in endothelial function in CAD patients correlated with reduced anginal symptoms.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Medical Technology
Background:
- Coronary artery disease (CAD) is often associated with impaired vascular endothelium.
- Endothelial dysfunction in CAD patients can be a target for therapeutic intervention.
- External counterpulsation (ECP) is known to alleviate angina and improve exercise tolerance, but its effect on endothelial function in refractory cases was unclear.
Purpose of the Study:
- To assess the short-term impact of external counterpulsation (ECP) therapy on flow-mediated dilation (FMD) in patients suffering from coronary artery disease (CAD).
- To investigate the potential of ECP to improve endothelial function in patients with refractory angina pectoris.
Main Methods:
- Prospective assessment of endothelial function in 20 CAD patients with refractory angina (CCS class III-IV) before and after ECP.
- Measurement of endothelium-dependent brachial artery FMD and endothelium-independent nitroglycerin (NTG)-mediated vasodilation using high-resolution ultrasound.
- Comparison of pre- and post-ECP measurements with 20 age- and gender-matched control subjects.
Main Results:
- ECP therapy led to a significant improvement in post-intervention FMD (8.2% vs. 3.1% in controls, p=0.01).
- No significant change was observed in NTG-induced vasodilation between ECP and control groups (p=0.85).
- ECP significantly reduced anginal symptoms, evidenced by decreased nitrate consumption (p<0.001) and improved CCS angina class (p<0.0001).
Conclusions:
- External counterpulsation therapy demonstrates a significant positive effect on vascular endothelial function in CAD patients with refractory angina.
- The observed improvement in anginal symptoms following ECP may be attributed to enhanced endothelial function.
- ECP represents a potential therapeutic strategy for improving vascular health and clinical outcomes in specific CAD populations.