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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
PubMed

Insights

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.
Abstract

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