Cardiovascular Effects of Long-Term Treatment with Enhanced External Counterpulsation in Patients with Ischemic Heart
Alexey S Lishuta1, Olga A Slepova1, Nadezhda A Nikolaeva1
1Department of Hospital Therapy No. 1, I. M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia.
Insights
Enhanced external counterpulsation (EECP) significantly improves vascular function and clinical outcomes in patients with ischemic chronic heart failure (CHF). More EECP courses led to better exercise tolerance and reduced cardiovascular event risk over 36 months.
Area of Science:
- Cardiology
- Vascular Medicine
- Heart Failure Management
Background:
- Enhanced external counterpulsation (EECP) is a potential treatment for ischemic chronic heart failure (CHF).
- Long-term vascular effects of EECP in CHF patients require further definition.
- This study investigates the vascular effects and clinical outcomes of long-term EECP in ischemic CHF.
Purpose of the Study:
- To assess the long-term vascular effects of EECP in patients with ischemic CHF.
- To evaluate the relationship between vascular improvements and clinical outcomes.
- To determine the optimal EECP regimen for long-term benefits.
Main Methods:
- 120 ischemic CHF patients randomized into three groups: one EECP course/year, two EECP courses/year, or placebo-counterpulsation/year.
- Annual assessments over 36 months included echocardiography, videocapillaroscopy, photoplethysmography, tonometry, and exercise testing.
- Clinical outcomes and event-free survival were monitored.
Main Results:
- Long-term EECP significantly increased exercise tolerance (23.5-45.0%) and improved left ventricular ejection fraction (9.9-19.6%) compared to placebo.
- EECP enhanced both functional and structural vascular parameters (p < 0.001).
- Higher EECP frequency correlated with greater improvements and the highest event-free survival.
Conclusions:
- Long-term EECP treatment improves vascular function and structure in ischemic CHF patients.
- Vascular parameter improvement is a strong predictor of reduced cardiovascular event risk after 36 months.
- The benefits of EECP are dose-dependent, with more frequent courses yielding superior outcomes.
Abstract:
(1) Background. Although treatment with enhanced external counterpulsation (EECP) in patients with ischemic chronic heart failure (CHF) is pathophysiologically justified, its long-term vascular effects remain insufficiently defined. We aimed to study the vascular effects of long-term complex treatment (36 months) including EECP in patients with ischemic CHF, and to examine the relationship between these effects and clinical outcomes. (2) Methods. A total amount of 120 patients with ischemic CHF were randomized to receive one course of EECP per year (35 h; Group 1), two courses of EECP per year (70 h; Group 2), or one course of placebo-counterpulsation per year (35 h; Group 0;). For a period of 36 months, all patients underwent annual assessments including transthoracic echocardiography, nailfold videocapillaroscopy, finger photoplethysmography, applanation tonometry, exercise tolerance testing, and clinical outcome monitoring. (3) Results. Compared to the placebo group, long-term EECP treatment in patients with ischemic CHF, was accompanied by a significantly greater increase in exercise tolerance (∆23.5-45.0% vs. 7.0%; p < 0.001) and improvements in left ventricular ejection fraction (∆9.9-19.6% vs. 5.6%; p < 0.001) and myocardial stress (decrease in NT-proBNP level ∆-80.4--82.4% vs. -75.8%; p < 0.001), as well as both functional and structural vascular parameters (p < 0.001). The effect size depended on the annual number of EECP courses. The highest event-free survival was found in Group 2. At 36 months, improvement of vascular parameters emerged as stronger predictors of reduced cardiovascular event risk compared to the 12-month. (4) Conclusions. Long-term EECP treatment of patients with ischemic CHF improves both functional and structural vascular parameters, with an increasing role of their improvement in reducing the risk of cardiovascular events after 36 months.
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