Enhanced external counterpulsation improved myocardial perfusion and coronary flow reserve in patients with chronic stable angina. Evaluation by13N-ammonia positron emission tomography

Abstract

Enhanced external counterpulsation therapy improved myocardial perfusion at rest and with dipyridamole and was associated with an increased exercise tolerance with(13)N-ammonia positron emission tomography and increased nitric oxide levels. These results suggest that one of the enhanced external counterpulsation mechanisms is development and recruitment of collateral vessels.

Enhanced external counterpulsation does not alter arterial stiffness in patients with angina

“…measured directly. 7 More recently, Bonetti et al did demonstrate an improvement in peripheral endothelial function that persisted up to 1 month after treatment. 8 Although related to endothelial function, arterial stiffness may vary in an endothelial-independent manner in different subjects.…”

“…23 On the other hand, several studies have demonstrated increased myocardial perfusion with associated release of endothelial growth factors, improved coronary endothelial function, and decreased neurohumeral factors, which may reflect improved ventricular hemodynamics. 3,[5][6][7] Hence, the bulk of the evidence to date suggests that EECP exerts its sustained clinical benefits through improvements in cardiac status, rather than benefitting the peripheral vascular system. Our study result supports this theory by failing to demonstrate any measurable change in central or peripheral arterial stiffness immediately or 4 months post completion of EECP therapy.…”

“…Studies to date mainly address the central effects; there may be increased coronary collateral vessel development resulting from diastolic augmentation and release of angiogenic growth factors. [5][6][7] Urano et al demonstrated improved left ventricular diastolic filling following EECP. 3 Improved coronary 7 and, more recently, peripheral endothelial function have been demonstrated up to 1 month after therapy.…”

“…[5][6][7] Urano et al demonstrated improved left ventricular diastolic filling following EECP. 3 Improved coronary 7 and, more recently, peripheral endothelial function have been demonstrated up to 1 month after therapy. 8 Left ventricular diastolic function and endothelial function are related to arterial stiffness, 9,10 but no study to date has examined the effect of EECP on large artery stiffness.…”

A historical perspective towards a non-invasive treatment for patients with atherosclerosis

“…15 Objective measures of coronary ischaemia have demonstrated improved time to ST-segment depression, stress myocardial perfusion, 16 and PET scan myocardial perfusion at rest and after dipyramidole. 17 Benefits have been demonstrated to be durable in many patients for up to five years after treatment. 18 Extracorporeal shock wave therapy Another proposed treatment for patients with severe coronary artery disease with no options for PCI or surgery is extracorporeal cardiac shock wave therapy (ECST).…”