Enhanced external counterpulsation improves endothelial function and exercise capacity in patients with ischaemic...

Area of Science:

• Cardiovascular Medicine
• Vascular Physiology
• Rehabilitation Therapy

Background:

• Enhanced external counterpulsation (EECP) therapy is known to reduce angina and improve quality of life in patients with left ventricular dysfunction (LVD).
• The precise mechanisms by which EECP exerts its effects, particularly in patients with LVD, require further elucidation.
• Understanding EECP's impact on endothelial function and exercise capacity is crucial for optimizing treatment strategies.

Purpose of the Study:

• To investigate the effects of EECP on endothelial function in peripheral conduit arteries.
• To assess the impact of EECP on exercise capacity, measured by peak oxygen consumption (peak Vo2).
• To compare the efficacy of EECP in patients with ischaemic LVD versus those with coronary artery disease (CAD) and preserved LV function.

Main Methods:

• A study involving patients with ischaemic LVD (ejection fraction [EF] 34.5 ± 4.2%) and symptomatic CAD with preserved LV function (EF 53.5 ± 6.6%).
• Patients underwent 35 sessions of EECP (1 hour per session).
• Brachial and femoral artery flow-mediated dilation (FMD) were measured using high-resolution ultrasound; plasma levels of nitrate/nitrite and prostacyclin, and peak Vo2 were also assessed before and after EECP.

Main Results:

• EECP significantly improved brachial and femoral artery FMD parameters in both LVD and CAD groups, with no significant differences between groups.
• Plasma levels of nitrate/nitrite and prostacyclin were significantly elevated post-EECP in both patient cohorts.
• Peak Vo2 significantly increased in both LVD and CAD groups following EECP therapy, with comparable improvements.

Conclusions:

• Enhanced external counterpulsation therapy effectively improves peripheral vascular endothelial function in patients with coronary artery disease.
• EECP therapy also enhances functional exercise capacity (peak Vo2) in patients with CAD, irrespective of left ventricular function.
• These findings suggest that EECP is a valuable therapeutic option for improving vascular health and exercise tolerance in a broad spectrum of CAD patients, including those with left ventricular dysfunction.