Comparison of patients undergoing enhanced external counterpulsation and spinal cord stimulation for refractory angina pectoris

Bondesson, Susanne; Pettersson, Thomas; Erdling, André; Hallberg, Ingalill Rahm; Wackenfors, Angelica; Edvinsson, Lars

doi:10.1097/mca.0b013e3283162489

Cited by 14 publications

(13 citation statements)

References 27 publications

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“…A significant reduction in angina pectoris was measured by CCS-class in the EECP group compared to the no EECP group. This symptom relief has earlier been demonstrated [30]. The possible mechanisms responsible for the improvement of the angina status include enhancement of the endothelial function, promotion of collateral circulation and improved ventricular function [31].…”

Section: Discussionmentioning

confidence: 73%

Reduced peripheral vascular reactivity in refractory angina pectoris: Effect of enhanced external counterpulsation

Bondesson

Edvinsson²,

Pettersson³

et al. 2012

Journal of Geriatric Cardiology

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AimsTo examine if the skin microvascular bed is altered and can be modified by enhanced external counterpulsation (EECP) in patients with chronic refractory angina.MethodsTwenty patients diagnosed with refractory angina were divided into EECP (n = 10) or no EECP (n = 10) groups. The data were compared to matched healthy subjects (n = 20). The cutaneous forearm microvascular blood flow was measured by Laser-Doppler flowmetry. The vascular responsiveness to iontophoretic administration of acetylcholine (ACh), sodium nitroprusside (SNP) and local skin warming were studied. Measurements of Canadian Cardiovascular Society (CCS)-class, blood pressure and plasma samples were registered.ResultsEECP patients showed reduced CCS-class compared to no EECP (P < 0.05). Both EECP and no EECP (P < 0.05) groups had decreased systolic blood pressure (SBP) as compared to SBP at baseline (P < 0.05). There was no difference in resting blood flow between the two refractory groups at baseline as well as after EECP and seven weeks of follow-up. Responses to heating, the responses to ACh and SNP in the cutaneous microcirculation were lower in both groups of refractory angina patients as compared to healthy subjects (P < 0.05). EECP patients corresponded positively to the treatment shown by reduced plasma level of soluble interleukin-2 receptor and CCS-class.ConclusionsRefractory angina patients have reduced responsiveness in their cutaneous microcirculation to ACh, SNP and heat compared to healthy subjects. Although EECP reduced the CCS-class, this effect was not associated with improvements in responsiveness of the cutaneous microcirculation.

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Section: Discussionmentioning

confidence: 73%

Reduced peripheral vascular reactivity in refractory angina pectoris: Effect of enhanced external counterpulsation

Bondesson

Edvinsson²,

Pettersson³

et al. 2012

Journal of Geriatric Cardiology

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“…Finally, changes in CCS classes were observed in 3 trials11,16,23 across all 12 including studies, and the logarithm of OR was used as effect size to assess differences in the proportion of patients having a decrease of 2 or more CCS classes (considered clinically significant). Efficacy comparison between SCS and control was OR 2.12 (1.19 to 3.76) with no heterogeneity (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…In particular, studies were excluded where patients had a myocardial infarction 6,11. We also excluded studies that had no relevant event in both the treatment or control groups, for the reason that these trials provided no information on the magnitude of the treatment effects.…”

Section: Methodsmentioning

confidence: 99%

Spinal Cord Stimulation for Refractory Angina Pectoris

Pan

Bao

et al. 2017

The Clinical Journal of Pain

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Objectives:Paresthesia-free stimulation such as high frequency and burst have been demonstrated as effective therapies for neuropathic pain. The aim of this meta-analysis was to evaluate the efficacy and safety of conventional spinal cord stimulation (SCS) in the treatment of refractory angina pectoris (RAP).Materials and Methods:Relevant randomized controlled trials that investigated SCS for patients with RAP were comprehensively searched in Medline, Pubmed, Embase, and Cochrane Library. Five meta-analyses were performed examining the changes in Canadian Cardiovascular Society classes, exercise time, Visual Analog Scale (VAS) scores of pain, Seattle Angina Questionnaire, and nitroglycerin use in RAP patients after SCS therapy. We analyzed standardized mean differences (MD) and 95% confidence intervals (CIs) for each outcome by Review Manager 5.0 and STATA 12.0.Results:A total of 12 randomized controlled trials involving 476 RAP patients were identified. A trend of reduction in the angina frequency (MD=−9.03, 95% CI, −15.70 to −2.36) and nitroglycerin consumption (MD=−0.64, 95% CI, −0.84 to −0.45) could be observed in the SCS group. Compared with the control group, SCS showed benefit on increasing exercise time (MD=0.49, 95% CI, 0.13-0.85) and treatment satisfaction (MD=6.87, 95% CI, 2.07-11.66) with decreased VAS scores of pain (MD=−0.50, 95% CI, −0.81 to −0.20) and disease perception (MD=−8.34, 95% CI, −14.45 to −2.23). However, the result did not reach the significance level in terms of physical limitation (95% CI, −8.75 to 3.38; P=0.39) or angina stability (95% CI, −7.55 to 3.67; P=0.50).Discussion:The current meta-analysis suggested that SCS was a potential alternative in the treatment of PAP patients. Further investigation for finding the appropriate intensity of stimulation is required before this treatment should be widely recommended and applied.

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“…Despite differences in these and other characteristics, including duration of follow‐up, and also protocols of SCS therapy (e.g., continuous vs. intermittent SCS, as well as stimulation frequency), these observational studies showed consistent results supporting significant beneficial effects of SCS in RAP patients (Table 2) (19,34–48).…”

Section: Observational Studies Of Scs In Rap Patientsmentioning

confidence: 91%

Effect of Spinal Cord Stimulation in Patients With Refractory Angina: Evidence From Observational Studies

Lanza

Barone

Monaco

2012

Neuromodulation: Technology at the Neural Interface

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Comparison of patients undergoing enhanced external counterpulsation and spinal cord stimulation for refractory angina pectoris

Cited by 14 publications

References 27 publications

Reduced peripheral vascular reactivity in refractory angina pectoris: Effect of enhanced external counterpulsation

Reduced peripheral vascular reactivity in refractory angina pectoris: Effect of enhanced external counterpulsation

Spinal Cord Stimulation for Refractory Angina Pectoris

Effect of Spinal Cord Stimulation in Patients With Refractory Angina: Evidence From Observational Studies

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