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Sequential external counterpulsation: an adjunctive therapy for patients with chronic coronary artery disease and
R R Kasliwal1, S Mittal, A Kanojia
1Escorts Heart Institute, Okhla Road, New Delhi.
Insights
Sequential external counterpulsation (SECP) significantly improved symptoms and cardiac function in patients with chronic coronary artery disease (CAD) and left ventricular (LV) dysfunction. This noninvasive therapy offers a valuable option for patients refractory to conventional treatments.
Area of Science:
- Cardiology
- Noninvasive Cardiovascular Therapeutics
Background:
- Chronic coronary artery disease (CAD) with left ventricular (LV) dysfunction poses significant challenges, especially in patients unresponsive to maximal medical therapy.
- Interventional or surgical options may not be suitable for all patients due to disease extent or comorbidities.
Purpose of the Study:
- To evaluate the clinical and hemodynamic benefits of a 3-week course of sequential external counterpulsation (SECP) therapy.
- To assess the utility of SECP in patients with chronic CAD and LV dysfunction who are not candidates for revascularization.
Main Methods:
- Twenty-three patients with chronic CAD and LV dysfunction received one-hour SECP sessions daily for three weeks.
- Clinical assessments, including anginal frequency and New York Heart Association (NYHA) class, were performed before and after therapy.
- Echocardiographic parameters, such as LV dimensions and ejection fraction (LVEF), were evaluated pre- and post-SECP.
Main Results:
- Anginal episodes decreased from 9 to 1 per week, and NYHA class III symptoms reduced from 74% to 8.7% of patients.
- All patients reported symptomatic improvement on a visual analog scale (mean improvement of 6.8 ± 1.4).
- SECP therapy led to a reduction in LV diastolic and systolic dimensions and an increase in LVEF (from 32.7% to 37.4%).
Conclusions:
- Three weeks of SECP therapy demonstrates significant improvements in symptomatic status for patients with chronic CAD and LV dysfunction.
- SECP enhances cardiac function, offering a promising noninvasive treatment for medically refractory patients.
- This therapy is a viable alternative for patients unsuitable for traditional interventions or surgery.
Abstract:
We assessed the clinical and haemodynamic improvement with 3 weeks of sequential external counterpulsation (SECP) therapy in 23 patients with chronic coronary artery disease (CAD) and left ventricular (LV) dysfunction who were refractory to maximal tolerated doses of medical therapy and in whom intervention or surgery was not contemplated. All patients were subjected to one-hour duration of SECP for 3 weeks. SECP is a new noninvasive tool which increases coronary artery filling utilizing external pressure in a sequential manner from calf to thigh. A detailed clinical and echocardiographic evaluation was done before and after the completion of therapy to assess the utility of SECP. There were 18 males and 5 females with a mean age of 53 years. On coronary angiography, 39 percent patients had single, 8.7 percent had double and 48 percent had triple vessel disease. Four patients had coronary artery bypass graft (CABG) surgery in the past. Out of all patients, 48 percent had diffuse or distal coronary artery disease which was considered not suitable for CABG, 22 percent were not willing for intervention and 30 percent had other systemic diseases making them unfit for surgery. After 3 weeks of SECP, the anginal frequency reduced from 9 episodes/week to 1 episode/week. Before SECP, 74 percent patients were in NYHA class III, whereas only 8.7 percent were class III symptomatic after SECP. All patients claimed symptomatic improvement of a mean of 6.8 +/- 1.4 on a visual analog scale of 1-10. After SECP, the LV diastolic dimensions reduced from 54.6 +/- 7 to 51 +/- 7 mm, systolic dimensions reduced from 40 +/- 8 to 36 +/- 8 mm and LVEF increased from 32.7 +/- 9 to 37.4 +/- 8.5 percent. In conclusion, 3 weeks of therapy with SECP produces significant improvement in symptomatic status and cardiac function in patients with chronic CAD and LV dysfunction, refractory to medical therapy.