Enhanced external counterpulsation for management of symptoms associated with long COVID

Sathyamoorthy, Mohanakrishnan; Verduzco‐Gutierrez, Monica; Varanasi, Swathi; Ward, R Parker; Spertus, John A.; Shah, Sachin A

doi:10.1016/j.ahjo.2022.100105

Cited by 7 publications

(7 citation statements)

References 5 publications

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“…A recent study indicated that physical exercising will play a substantial role in the rehabilitation of COVID-19 survivors suffering from PASC as it positively affects both physical and mental dimensions as well as work ability [ 35 ]. Another study reported that EECP improved the quality of life and fatigue in patients with PASC and allowing them to resume normal daily activities and return to work [ 34 ], which are findings similar to ours. In the present study, the physical limitation patients had hindered them from exercising to the extent they needed to gain benefits.…”

Section: Discussionsupporting

confidence: 89%

“…Since patients with fatigue may also suffer from brain fog, myalgia, and depression/anxiety, more research is needed to identify treatment options which might be helpful against these symptoms and conditions [ 32 ]. Case reports and smaller studies have described EECP as helpful for neurocognitive symptoms in patients with PASC-associated symptoms [ 1 , 21 , 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

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Enhanced External Counterpulsation for Management of Postacute Sequelae of SARS-CoV-2 Associated Microvascular Angina and Fatigue: An Interventional Pilot Study

Wu,

Mahdi,

Nickander

et al. 2023

Cardiology Research and Practice

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Background. Postacute sequelae of SARS-CoV-2 infection (PASC) are a novel clinical syndrome characterized in part by endothelial dysfunction. Enhanced external counterpulsation (EECP) produces pulsatile shear stress, which has been associated with improvements in systemic endothelial function. Objective. To explore the effects of EECP on symptom burden, physical capacity, mental health, and health-related quality of life (HRQoL) in patients with PASC-associated angina and microvascular dysfunction (MVD). Methods. An interventional pilot study was performed, including 10 patients (male = 5, mean age 50.3 years) recruited from a tertiary specialized PASC clinic. Patients with angina and MVD, defined as index of microcirculatory resistance (IMR) ≥25 and/or diagnosed through stress perfusion cardiac magnetic resonance imaging, were included. Patients underwent one modified EECP course (15 one-hour sessions over five weeks). Symptom burden, six-minute walk test, and validated generic self-reported instruments for measuring psychological distress and HRQoL were assessed before and one month after treatment. Results. At baseline, most commonly reported PASC symptoms were angina (100%), fatigue (80%), and dyspnea (80%). Other symptoms included palpitations (50%), concentration impairment (50%), muscle pain (30%), and brain fog (30%). Mean IMR was 63.6. After EECP, 6MWD increased (mean 29.5 m, median 21 m) and angina and fatigue improved. Mean depression scores showed reduced symptoms (−0.8). Mean HRQoL scores improved in seven out of eight subscales (+0.2 to 10.5). Conclusions. Patients with PASC-associated angina and evidence of MVD experienced subjective and objective benefits from EECP. The treatment was well-tolerated. These findings warrant controlled studies in a larger cohort.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Enhanced External Counterpulsation for Management of Postacute Sequelae of SARS-CoV-2 Associated Microvascular Angina and Fatigue: An Interventional Pilot Study

Wu,

Mahdi,

Nickander

et al. 2023

Cardiology Research and Practice

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“…In line with the benefits of cardiac rehabilitation, other techniques such as enhanced external counterpulsation may also positively influence the quality of life of affected individuals. As recently shown in a retrospective study, convalescent COVID-19 patients improved several indices associated with quality of life and exercise capacity after 15–35 treatment sessions [ 64 ]. It may also enhance cognitive function in affected individuals [ 65 ].…”

Section: Discussionmentioning

confidence: 91%

The Role of Rehabilitation in Arterial Function Properties of Convalescent COVID-19 Patients

Gounaridi

Vontetsianos

Oikonomou

et al. 2023

JCM

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Coronavirus disease (COVID-19) is a respiratory disease, although arterial function involvement has been documented. We assess the impact of a post-acute COVID-19 rehabilitation program on endothelium-dependent vasodilation and arterial wall properties. We enrolled 60 convalescent patients from COVID-19 and one-month post-acute disease, who were randomized at a 1:1 ratio in a 3-month cardiopulmonary rehabilitation program (study group) or not (control group). Endothelium-dependent vasodilation was evaluated by flow-mediated dilation (FMD), and arterial wall properties were evaluated by carotid–femoral pulse wave velocity (cf-PWV) and augmentation index (AIx) at 1 month and at 4 months post-acute disease. FMD was significantly improved in both the study (6.2 ± 1.8% vs. 8.6 ± 2.4%, p < 0.001) and control groups (5.9 ± 2.2% vs. 6.6 ± 1.8%, p = 0.009), but the improvement was significantly higher in the study group (rehabilitation) (p < 0.001). PWV was improved in the study group (8.2 ± 1.3 m/s vs. 6.6 ± 1.0 m/s, p < 0.001) but not in the control group (8.9 ± 1.8 m/s vs. 8.8 ± 1.9 m/s, p = 0.74). Similarly, AIx was improved in the study group (25.9 ± 9.8% vs. 21.1 ± 9.3%, p < 0.001) but not in the control group (27.6 ± 9.2% vs. 26.2 ± 9.8 m/s, p = 0.15). Convalescent COVID-19 subjects of the study group (rehabilitation) with increased serum levels of circulating IL-6 had a greater reduction in FMD. Conclusively, a 3-month cardiopulmonary post-acute COVID-19 rehabilitation program improves recovery of endothelium-dependent vasodilation and arteriosclerosis.

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“…Studies have shown that EECP improves endothelial function in patients with symptomatic coronary artery disease 25 and enhances myocardial perfusion in patients with chronic stable angina 26 . More recently, a small retrospective study involving Long COVID‐19 patients without obstructive coronary artery disease reported significant improvements in Seattle Angina Questionnaire scores (21.44 ± 16.54, p < 0.001) after 15–35 sessions of EECP, and 63% of patients experienced an improvement in Canadian Cardiovascular Society Angina Grade 27 . Our patient had endothelial‐independent and ‐dependent microvascular dysfunction as well as evidence of epicardial coronary artery vasospasm.…”

Section: Discussionmentioning

confidence: 99%

COVID‐19 STEMI related to microthrombi may lead to coronary microvascular dysfunction

Aziz,

Yildiz,

Quesada

et al. 2023

Cathet Cardio Intervent

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Coronavirus disease 2019 (COVID‐19) increases the risk of ST‐segment elevation myocardial infarction (STEMI), and is associated with a higher occurrence of nonobstructive coronary artery disease. We present a unique case of STEMI with concomitant COVID‐19 infection in a young female found to have slow flow in multiple vessels on angiography, likely due to microvascular thrombi. Three months later, the patient developed coronary microvascular dysfunction (CMD), suggesting an evolution of microvascular thrombi and injury into subsequent CMD.

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Enhanced external counterpulsation for management of symptoms associated with long COVID

Cited by 7 publications

References 5 publications

Enhanced External Counterpulsation for Management of Postacute Sequelae of SARS-CoV-2 Associated Microvascular Angina and Fatigue: An Interventional Pilot Study

Enhanced External Counterpulsation for Management of Postacute Sequelae of SARS-CoV-2 Associated Microvascular Angina and Fatigue: An Interventional Pilot Study

The Role of Rehabilitation in Arterial Function Properties of Convalescent COVID-19 Patients

COVID‐19 STEMI related to microthrombi may lead to coronary microvascular dysfunction

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