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[Pilot experience in Russia with external contrapulsation in patients with coronary heart disease]
Insights
Programmed external counterpulsation (ECP) significantly improves quality of life and exercise tolerance in patients with coronary heart disease (CHD) and refractory angina. This therapy offers a safe and effective treatment option for managing symptoms and improving cardiac function.
Area of Science:
- Cardiology
- Internal Medicine
- Medical Technology
Background:
- Coronary heart disease (CHD) with stable angina often presents challenges in management, particularly when resistant to conventional medication.
- Patients with refractory angina may have limited treatment options, especially if myocardial revascularization is not feasible.
Purpose of the Study:
- To evaluate the impact of programmed external counterpulsation (ECP) on clinical status, functional capacity, and quality of life (QOL) in patients with medication-resistant stable angina.
- To assess the safety and efficacy of ECP as an adjunct therapy in patients with CHD, including those with co-existing cardiac failure.
Main Methods:
- A cohort of 18 patients with CHD and stable angina (FC III-IV) underwent a course of 35 one-hour ECP sessions over 7 weeks.
- Assessments included quality of life questionnaires, echocardiography, exercise tolerance tests, myocardial perfusion scintigraphy, 24-hour ECG monitoring, and biomarker analysis.
Main Results:
- All patients reported significant subjective improvements in quality of life (p < 0.01).
- Anginal attacks and nitrate requirements decreased by at least 50%. Exercise tolerance significantly increased (p < 0.01).
- Improvements were observed in myocardial perfusion, left ventricular ejection fraction (in patients with impaired contractility), and a significant reduction in mean heart rate (p < 0.02).
Conclusions:
- Programmed external counterpulsation (ECP) demonstrates high effectiveness and safety as a combined therapy for coronary heart disease and stable angina resistant to drug treatment.
- ECP is a viable option for patients unsuitable for myocardial revascularization, including those with cardiac failure, leading to reduced angina, improved exercise tolerance, and enhanced quality of life.
Aim:
To examine effects of programmed external contrapulsation (ECP) on the clinico-functional status, quality of life (QOL) in patients with coronary heart disease (CHD), stable angina of FC II-IV resistant to medication.
Material And Methods:
Eighteen patients with CHD, stable angina of FC III-IV (2 females and 16 males, mean age 63.6 +/- 7.4 years) have completed a course of ECP including 35 one-hour procedures 5-6 times a week for 7 weeks. Ten patients had cardiac failure (NYHA FC II-III). Before and after ECP course the patients were examined using QOL assessment by Minnesota questionnaire, complex echo-cardiography, bicycle exercise test, perfusion myocardial scintigraphy with 99m-Tc-4,2-methoxy-isobutilisonitril, 24-h Holter ECG monitoring, enzyme immunoassay for plasma natriuretic propeptides.
Results:
Significant subjective QOL improvement (p < 0.01) was noticed by all the patients. Anginal attacks and nitrates doses reduced at least 2-fold. Exercise tolerance rose significantly (p < 0.01), bicycle exercise test was positive in 5 patients, the rest stopped the test after achievement of submaximal heart rate (HR) and fatigue. Most of the patients exhibited improvement of myocardial perfusion. Patients with abnormal myocardial contractility showed a moderate trend (p < 0.03) to an increase in left ventricular ejection fraction. By 24-h ECG, mean HR diminished significantly (p < 0.02).
Conclusion:
ECP is highly effective and safe in combined therapy of CHD, stable angina resistant to drug therapy, in impossibility of myocardial revascularization, including patients with cardiac failure. This manifests in a significant abatement of angina, lower doses of nitrates, improvement of exercise tolerance, quality of life, myocardial perfusion and hemodynamic indices.
