Enhanced external counterpulsation improves endothelial function in patients with symptomatic coronary artery disease

Bonetti, Piero O.; Barsness, Gregory W.; Keelan, Paul C.; Schnell, Theresa I.; Pumper, Geralyn M.; Kuvin, Jeffrey T.; Schnall, Robert P.; Holmes, David R.; Higano, Stuart T.; Lerman, Amir

doi:10.1016/s0735-1097(03)00329-2

Cited by 373 publications

(336 citation statements)

References 34 publications

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“…This method has been validated and described previously in other populations16, 17, 18, 19, 20 and in patients with AF 21. After a 5‐minute baseline measurement, the blood pressure cuff on the test arm was inflated to 60 mm Hg above baseline systolic blood pressure or a maximum of 200 mm Hg for 5 minutes.…”

Section: Methodsmentioning

confidence: 99%

Age‐Dependent Predictive Value of Endothelial Dysfunction for Arrhythmia Recurrence Following Pulmonary Vein Isolation

Matsuzawa

Suleiman

Guddeti

et al. 2016

JAHA

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BackgroundThe mechanisms of atrial fibrillation (AF) are highly divergent. The prevalence of AF increases significantly with age, and underling mechanisms might vary with age. Endothelial dysfunction may be associated with AF and atrial arrhythmia recurrence after catheter ablation. We tested the hypothesis that the impact of endothelial dysfunction on arrhythmia recurrence following catheter ablation is age dependent.Methods and ResultsThis study enrolled 92 participants with AF undergoing catheter ablation. Endothelial function was assessed by peripheral arterial tonometry before ablation, and the natural logarithmic transformation of reactive hyperemia index was calculated. Endothelial dysfunction was defined as a natural logarithmic transformation of reactive hyperemia index <0.618 (median). Participants were followed for atrial tachycardia, flutter, and fibrillation recurrence for a median of 14 months. The mean age was 57±10 years. There was significant interaction between age and endothelial dysfunction in association with recurrence of AF (P=0.029) and any atrial arrhythmia (P=0.015), and the risk associated with endothelial dysfunction for arrhythmia recurrence was higher in younger versus older participants. Participants were divided into 2 age groups at a threshold of 60 years. Among participants aged ≤60 years, multivariate Cox proportional hazards analysis revealed the independent association between endothelial dysfunction and increased risk of arrhythmia recurrence (hazard ratio for AF 4.18 [95% CI 1.33–15.82], P=0.014, and for any atrial arrhythmia 3.62 [95% CI 1.29–11.81], P=0.014). Kaplan–Meier analysis showed that participants with endothelial dysfunction had significantly higher rates of recurrence of AF (P=0.01) and any atrial arrhythmia (P=0.002).ConclusionsThe risk associated with endothelial dysfunction for arrhythmia recurrence following catheter ablation was age dependent and was higher in younger participants.

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Section: Methodsmentioning

confidence: 99%

Age‐Dependent Predictive Value of Endothelial Dysfunction for Arrhythmia Recurrence Following Pulmonary Vein Isolation

Matsuzawa

Suleiman

Guddeti

et al. 2016

JAHA

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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. Arterial stiffness or compliance can be measured noninvasively by a number of methods, including pulse wave velocity (PWV) and pulse wave analysis.…”

Section: Introductionmentioning

confidence: 99%

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

Dockery

Rajkumar

Bulpitt

et al. 2004

Clinical Cardiology

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SummaryBackground: Enhanced external counterpulsation (EECP) is a noninvasive treatment for angina that acutely augments diastolic pressure and reduces cardiac afterload. However, the mechanism of the sustained clinical benefit seen with this therapy is not known.Hypothesis: The study aimed to determine whether EECP leads to an improvement in arterial stiffness.Methods: In all, 22 men and 1 woman with angina (age 63.6 ± 6.7 years, mean ± SD) were studied prior to and after 35 h of EECP therapy over 7 weeks. We measured carotid-radial (C-R) pulse wave velocity (PWV), and aortic augmentation index (AI) was derived from radial and carotid artery waveforms using applanation tonometry. Seventeen patients underwent treadmill exercise testing before and after the 7 weeks of EECP.Results: After EECP therapy, despite a significant improvement in treadmill exercise time and a reduction in systolic and diastolic blood pressures, there was no significant change in any arterial stiffness parameters: Mean C-R PWV was 8.4 ± 0.8 m/s at baseline and 8.0 ± 1.2 m/s after 7 weeks of EECP, mean change: -0.4, 95% confidence interval (CI): Ϫ1.0, + 0.2, p = 0.17. Mean radial-derived AI was 25.7 ± 10.4% before and 24.6 ± 10.8% after, mean change: + 1.1%, 95% CI: Ϫ2.3, + 4.5, p = 0.53. Median AI-carotid was 31.5% before and 28.7% after; median change: Ϫ0.5, interquartile range: Ϫ9.5, + 3.5, p = 0.32. Nineteen patients returned for 6-month recordings; neither blood pressure nor arterial stiffness readings were significantly different from baseline.Conclusion: Enhanced external counterpulsation therapy does not significantly alter arterial stiffness. Other than an initial reduction in blood pressure, the sustained clinical benefit

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“…There is increasing interest in the use of EECP in patients with established coronary disease for whom EECP might be used as an alternative to traditional revascularization, extending to a potential role in secondary and primary prevention of cardiovascular events. 7 Currently, EECP treatment is largely restricted to patients with refractory and severely disabling angina partly because of reimbursement coverage of only patients with CCS class III and IV angina by the Centers for Medicare and Medicaid Services (CMS). The present study was conducted to evaluate the potential benefit of EECP in treating refractory patients with less severely disabling (CCS class II) angina.…”

Section: Introductionmentioning

confidence: 99%

Two-year outcomes in patients with mild refractory angina treated with enhanced external counterpulsation

et al. 2006

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Background: In the International Enhanced External Counterpulsation Patient Registry (IEPR), approximately 85% of the patients treated are in Canadian Cardiovascular Society (CCS) class III‐IV with no option for further invasive coronary revascularization procedures. Hypothesis: This study sought to determine whether it is clinically important to establish whether the observed durable reduction in disabling severe angina with enhanced external counterpulsation (EECP) treatment can be extended to those with less severe CCS class II angina, who also have no option for further revascularization. Methods: This study evaluated the immediate response, durability and clinical events over a 2‐year period after EECP treatment in 112 patients with Canadian Cardiovascular Society (CCS) class II angina versus 1,346 patients with class III‐IV angina using data from the International EECP Patient Registry (IEPR). Results: Treatment with EECP significantly (by at least one CCS class) reduced angina frequency, nitroglycerinuse, and improved quality of life in both groups. At 2‐yearfollow‐up, 74% of class II and 70% of class III‐IV patients remained free of major adverse cardiovascular events (MACE) and continued to demonstrate a durable CCS class improvement over baseline. Conclusion: The robust effectiveness of EECP as a noninvasive device, together with its relatively low start‐up and recurrent costs, makes it an attractive consideration for treating patients with milder refractory angina in addition to the patient with severely disabling angina treated in current practice.

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Enhanced external counterpulsation improves endothelial function in patients with symptomatic coronary artery disease

Cited by 373 publications

References 34 publications

Age‐Dependent Predictive Value of Endothelial Dysfunction for Arrhythmia Recurrence Following Pulmonary Vein Isolation

Age‐Dependent Predictive Value of Endothelial Dysfunction for Arrhythmia Recurrence Following Pulmonary Vein Isolation

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

Two-year outcomes in patients with mild refractory angina treated with enhanced external counterpulsation

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