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Enhanced external counterpulsation increases coronary flow reserve in coronary microvascular disease

Qian Wang1, Jia Hao1, Wenjun Jiang1

  • 1From the Department of Cardiology, The first hospital of Qinhuangdao, Hebei Medical University, Qinhuangdao, Hebei, China.

Saudi Medical Journal
|November 28, 2023
PubMed

Insights

Enhanced external counterpulsation (EECP) improved coronary flow reserve (CFR) and quality of life in coronary microvascular disease (CMD) patients. EECP therapy significantly enhanced CFR and patient-reported outcomes.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Non-invasive Cardiology

Background:

  • Coronary microvascular disease (CMD) presents a significant challenge in cardiovascular medicine.
  • Limited effective treatment options exist for patients with CMD, impacting their quality of life.
  • Understanding novel therapeutic approaches for CMD is crucial for improving patient outcomes.

Purpose of the Study:

  • To evaluate the efficacy of enhanced external counterpulsation (EECP) in patients diagnosed with coronary microvascular disease (CMD).
  • To assess the impact of EECP on coronary flow reserve (CFR), endothelial function markers, and quality of life (QoL) in CMD patients.

Main Methods:

  • A randomized controlled trial involving 83 coronary microvascular disease patients, divided into EECP (n=41) and control (n=42) groups.
  • Coronary flow reserve (CFR) was measured using transthoracic Doppler echocardiography before and after a 4-week intervention period.
  • Serum levels of endothelial nitric oxide synthase (eNOS) and endothelin-1 (ET-1) were quantified using ELISA, alongside quality of life assessments via the Seattle Angina Questionnaire (SAQ) and Canadian Cardiovascular Society (CCS) angina class.

Main Results:

  • The EECP group demonstrated a significant improvement in CFR compared to the control group (p<0.05) after four weeks.
  • EECP therapy led to a significant reduction in endothelin-1 and a significant upregulation of eNOS in the EECP cohort.
  • Patients receiving EECP showed enhanced Seattle Angina Questionnaire scores and a reduction in Canadian Cardiovascular Society angina class.

Conclusions:

  • Enhanced external counterpulsation (EECP) is a promising non-invasive therapy for improving coronary flow reserve in patients with coronary microvascular disease (CMD).
  • EECP treatment positively impacts endothelial function markers, specifically increasing eNOS and decreasing ET-1.
  • EECP significantly enhances the quality of life for patients suffering from coronary microvascular disease, reducing angina symptoms.
Abstract

Keywords:
coronary flow reservecoronary microvascular diseaseendothelial functionenhanced external counterpulsation

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