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

Darren T Beck1, Jeffrey S Martin, Darren P Casey

  • 1Department of Kinesiology, University of Rhode Island, Kingston, RI, USA.

Clinical and Experimental Pharmacology & Physiology
|May 28, 2014
PubMed

Insights

Enhanced external counterpulsation (EECP) therapy significantly improves vascular function and exercise capacity in patients with left ventricular dysfunction (LVD). These benefits were observed to be similar in patients with coronary artery disease (CAD) and preserved LV function.

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.

Keywords:
coronary artery diseaseendothelial functionenhanced external counterpulsationleft ventricular dysfunctionvasoactive biomarkers

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