Evaluation of left ventricular systolic and diastolic regional function after enhanced external counter pulsation
Maryam Esmaeilzadeh1, Arsalan Khaledifar, Majid Maleki
1Department of Echocardiography, Shaheed Rajaie Cardiovascular Medical and Research Center, PO Box 1996911151, Vali-Asr Avenue, Adjacent to Mellat Park, Tehran, Iran. m_eszadeh@yahoo.com
Insights
Enhanced external counter pulsation (EECP) therapy significantly improved myocardial mechanical properties and cardiac function in patients with chronic coronary artery disease (CAD). This non-invasive treatment enhanced both systolic and diastolic functions, leading to reduced angina symptoms.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Non-invasive Cardiac Therapies
Background:
- Coronary artery disease (CAD) remains a leading cause of morbidity and mortality.
- Symptomatic patients often have refractory angina despite optimal medical management.
- Enhanced external counter pulsation (EECP) is a non-pharmacological therapy, but its impact on myocardial mechanics in refractory CAD is not well-established.
Purpose of the Study:
- To evaluate the effects of EECP on myocardial mechanical properties and cardiac function in CAD patients ineligible for revascularization.
- To assess improvements in systolic and diastolic functions using echocardiography.
Main Methods:
- Twenty patients with NYHA Class III/IV angina underwent a 7-week EECP protocol (1 hr/day, 5 days/week).
- Comprehensive echocardiography, including tissue Doppler imaging, assessed systolic and diastolic functions before and after EECP.
- Key parameters evaluated included transmitral inflow velocities, mitral annular velocities, LV ejection fraction, and strain rates.
Main Results:
- EECP significantly improved various echocardiographic parameters, including peak late diastolic transmitral inflow velocity, propagation velocity, and mitral annular velocities.
- Significant increases were observed in peak systolic velocity, early diastolic velocity, peak systolic strain rate, and peak systolic strain in basal and middle segments.
- Left ventricular ejection fraction improved significantly, alongside a decrease in E/A and E/Ea ratios, indicating improved diastolic function. Patients also showed a reduction in angina class.
Conclusions:
- EECP therapy demonstrates efficacy in enhancing both regional and global left ventricular systolic and diastolic functions in patients with chronic angina pectoris.
- The findings suggest EECP is a valuable therapeutic option for improving cardiac mechanics and function in select CAD patients.
Aims:
Enhanced external counter pulsation (EECP) is a non-invasive and non-pharmacological therapy for patients with symptomatic coronary artery disease (CAD). There are, however, insufficient data to support the effectiveness of EECP in improving the myocardial mechanical properties of patients with refractory stable angina. We aimed to assess the effects of EECP on myocardial mechanical properties and cardiac functions in CAD patients not eligible for surgical or percutaneous revascularization procedures.
Methods And Results:
Twenty patients in New York Heart Association (NYHA) functional Class III and IV angina were evaluated. The mean age of the patients was 63 +/- 9 years, and 65% were male. A comprehensive echocardiographic study including an evaluation of the tissue Doppler-based parameters of systolic and diastolic functions was performed before and after the termination of the protocol. EECP was carried out 1 h per day, 5 days per week, for 7 weeks. EECP resulted in a significant increase in peak late diastolic transmitral inflow velocity (0.75+/-0.14 vs. 0.83+/-0.20 m/s, P<0.05), propagation velocity (42.35+/-6.25 vs. 46.00+/-5.68 cm/s, P<0.05), peak early diastolic velocity of mitral annulus (5.35+/-1.79 vs. 5.95+/-1.10 cm/s, P<0.05), peak systolic velocity (2.51+/-0.28 vs. 2.67+/-0.26, P<0.05), and early diastolic velocity (3.24+/-0.18 vs. 3.52+/-0.26 cm/s, P<0.01) of all middle segments, peak late diastolic velocity of all basal (4.48+/-0.58 vs. 4.75+/-0.70 cm/s, P<0.05) and middle segments (2.82+/-0.66 vs. 3.25+/-0.46 cm/s, P<0.01), peak systolic strain rate of all basal (0.76+/-0.07 vs. 0.99+/-0.08 1/s, P=0.001) and middle segments (0.75+/-0.09 vs. 0.94+/-0.09 1/s, P<0.001), peak systolic strain of basal (11.64+/-1.51 vs. 13.97+/-1.52%, P<0.01) and middle segments (11.81+/-1.15 vs.13.73+/-1.57%, P<0.001), and left ventricular (LV) ejection fraction (40.25+/-12.72 vs. 46.25+/-12.97%, P<0.001).There was also a significant decrease in the ratios of transmitral E/A (0.92+/-0.41 vs. 1.08+/-0.46, P<0.05) and E/Ea (12.61+/-4.22 vs. 15.44+/-6.96, P<0.05) after EECP therapy. A significant reduction in NYHA angina class (>or=1 angina class) was seen in the patients, who completed treatment.
Conclusion:
EECP therapy seemed to improve both regional and global LV systolic and diastolic functions in patients with chronic angina pectoris.
