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EECP intervention and coronary flow reserve in chronic coronary syndrome: a protocol of a multicentre, randomised
Yanlong Leng1, Yuan Li1, Xue Jia1
1Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China.
Insights
Enhanced external counterpulsation (EECP) may improve coronary artery function in chronic coronary syndrome (CCS) patients. This study uses non-invasive FFRCT to assess EECP
Area of Science:
- Cardiology
- Medical Technology
- Clinical Trials
Background:
- Limited non-invasive methods exist to enhance coronary function in intermediate-risk chronic coronary syndrome (CCS) patients.
- Enhanced external counterpulsation (EECP) is a recommended CCS treatment, but its effect on coronary function needs quantitative validation.
- Fractional flow reserve computed tomography angiography (FFRCT) offers a non-invasive alternative to invasive Fractional flow reserve (FFR) for assessing coronary artery function.
Purpose of the Study:
- To investigate if EECP therapy improves FFRCT in intermediate-risk CCS patients.
- To evaluate EECP's potential to enhance long-term prognosis in CCS patients.
Main Methods:
- A prospective, multicentre, randomized controlled trial involving 104 participants.
- Participants are divided into EECP and control groups.
- The primary outcome is the between-group difference in FFRCT changes from baseline to follow-up.
Main Results:
- The study is designed to compare changes in FFRCT between the EECP and control groups.
- Secondary outcomes include differences in ΔFFRCT, hemodynamic parameters, exercise capacity, and clinical endpoints.
Conclusions:
- This study pioneers the use of non-invasive FFRCT to assess EECP efficacy in CCS.
- It aims to provide comprehensive evidence on EECP's benefits, including exercise capacity, symptom relief, and prognosis.
- Findings could inform future CCS treatment strategies.
Background:
Few non-invasive approaches are available for improving coronary function in intermediate-risk chronic coronary syndrome (CCS) patients. Over the past 30 years, enhanced external counterpulsation (EECP) has been widely accepted and recommended for treating CCS in clinical guidelines. However, the effect of EECP on coronary function remains to be quantitatively validated in intermediate-risk CCS patients. Fractional flow reserve (FFR) is a gold standard (quantitative index) of coronary artery function, and FFR < 0.80 is regarded as an indicator for percutaneous coronary intervention (PCI) in clinical decision-making. However, FFR is invasive and cannot be performed repeatedly within a short time interval; therefore, FFR is not suitable for large-scale verification of the effect before and after EECP treatment. Conversely, with advancements in numerical theory and computation hardware, FFR derived from coronary computed tomography angiography (FFRCT) performs similarly to FFR used in coronary artery function measurement. Additionally, FFRCT is non-invasive and highly acceptable to patients. Therefore, in this study, we aim to explore whether EECP therapy can improve FFRCT in patients with intermediate-risk CCS and further enhance the long-term prognosis of CCS.
Methods:
This prospective, multicentre, randomised controlled trial is blinded to the examination executors and analysts. One hundred four participants will be recruited, and they will be divided into the EECP and control groups. The primary outcome of this study is the between-group difference in FFRCT changes from baseline to follow-up. The secondary outcomes refer to between-group differences in ΔFFRCT, wall shear stress, axial plaque stress, total exercise time, time to 1 mm ST-segment depression, Seattle Angina Questionnaire score, and cardiovascular-related composite endpoint events.
Discussion:
This is the first study to use the non-invasive coronary artery function index, FFRCT, to evaluate the efficacy of EECP in patients with CCS. It comprehensively evaluates the treatment efficacy from multiple dimensions, including exercise capacity, symptom changes, and prognosis. Therefore, this will potentially provide reliable evidence to inform treatment strategies for CCS.
Trial Registration:
Trial registration number: ChiCTR2400079915. Registered on January 16, 2024 (retrospectively registered), https://www.chictr.org.cn/about.html.
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