Possibilities of Enhanced External Counterpulsation Using in Clinical Practice

Aim. To study the mid-term effects of enhanced external counterpulsation (EECP) in the structural and functional parameters of blood vessels, exercise tolerance and quality of life indicators in patients with verified coronary artery disease (CAD).Material and methods. Patients (n=70) with verified stable CAD (angina pectoris class II-III) complicated by chronic heart faillure class II-III (NYHA) were included in the study. Data from 65 patients (48 to 74 years old; 45 men and 20 women) are included in the final analysis. All patients had a course of EECP (35 hours procedures with a compression pressure of 220-280 mm Hg). All patients at baseline, 3 and 6 months later had a 6 walk minute test (6WMT), an assessment of the clinical status, quality of life of patients (Minnesota Living with Heart Failure Questionnaire, SF-36). Computer nailfold video capillaroscopy, photoplethysmography with pulse wave recording and contour analysis, applanation tonometry to assess central aortic systolic pressure and radial augmentation index were performed to assess the structural and functional state of large and microcirculatory vessels.Results. Significant improvement in exercise tolerance both after 3 and after 6 months (increase in distance in 6WMT by 44.6% after 3 months and 34.3% after 6 months, p <0.05), improved quality of life (increased overall score on the SF-36 questionnaire from 50.3±8.1 to 59.8±8.8, p<0.05), an increase in the left ventricular ejection fraction were found. Significant improvement in indicators showing the function of the endothelium of both large vessels (phase shift: from 5.6 [2.45; 7.3] to 6.8 [3.1; 8.1] m / s) and microcirculatory vessels (occlusion index: from 1.51 [1.21; 1.7] to 1.66 [1.2; 1.9]), as well as a decrease in functional disorders of the capillary bed of the skin (% of perfused capillaries, density of the capillary network in the test with reactive hyperemia) were found after 3 months. However, after 6 months, there were no significant changes in these parameters compared to the baseline value. No significant change in indicators showing structural remodeling of both large vessels and microcirculatory vessels was found.Conclusion. The positive effect of the EECP course on the functional status (exercise tolerance) and quality of life in patients with stable coronary artery disease complicated by chronic heart faillure was found both after 3 and 6 months. Positive dynamics of the functional state of large vessels and microvasculature was found only after 3 months.

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Medium-term Effects of Enhanced External Counterpulsation in the Structural and Functional Parameters of Blood Vessels in Patients with Coronary Artery Disease

Karaganov

Slepova

Лишута

et al. 2021

Racionalʹnaâ farmakoterapiâ v kardiologii

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A multimorbid patient with heart failure and long-term treatment with enhanced external counterpulsation: a case report

Lishuta,

Slepova,

Nikolaeva

et al. 2024

Cardiovasc Ther Prev

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Management of multimorbid patients is challenging, despite advances in pharmacotherapy and widespread use of surgical treatment. The combination of diseases such as coronary artery disease leading to heart failure, hypertension, type 2 diabetes and chronic kidney disease requires an individualized approach to the patient. Adjuvant non-invasive therapies could facilitate the management of such patients. In addition, the use of longer-term non-pharmacological treatment is associated with prolonged follow-up by medical personnel, which can improve patient adherence to therapy and, thus, their quality of life.This article presents a case of long-term follow-up and complex management of a patient with multimorbid pathology, including heart failure of ischemic etiology, with the addition of enhanced external counterpulsation in intermittent mode to therapy.

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Enhanced external counterpulsation in the management of patients with ischemic heart failure: long-term impact on clinical outcomes

Lishuta,

Privalova,

Belenkov

2024

Cardiovasc Ther Prev

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Aim. To study the long-term effect of complex therapy with enhanced external counterpulsation (EECP) on clinical parameters and outcomes in patients with stable coronary artery disease (CAD) complicated by heart failure (HF).Material and methods. The randomized trial EXCEL (Long-term Effects of enhanced eXternal CountErpuLsation; NCT05913778) included 118 patients with stable CAD complicated by New-York Heart Association (NYHA) class II-III HF, who were randomized into group 1 (n=59) receiving optimal therapy and EECP (35 hours, 2 courses/ year) or group 2 (n=59) receiving optimal therapy and EECP (35 hours, 1 course/year). The 6-minute walk test (6MWT), clinical status, quality of life (MLHFQ questionnaire), N-terminal pro-brain natriuretic peptide (NT-proBNP) level, left ventricular ejection fraction, and clinical outcomes were assessed annually.Results. In both groups, improvement of HF functional class, clinical status, exercise tolerance, NT-proBNP level, and quality of life were noted. Primary endpoint (increase in 6MWT distance >20%) in groups 1 and 2 was recorded in 100 and 79,7% of patients, respectively (p<0,001), while composite endpoint (myocardial infarction, revascularization, all-cause death, hospitalization for HF, new cases of atrial fibrillation, type 2 diabetes, stage 3-5 chronic kidney disease) in 18,6 and 52,5%, respectively. The odds ratio for primary and composite endpoint in group 1 was 0,207 (95% confidence interval: 0,090-0,475; p<0,001) and 0,032 (95% confidence interval 0,002-0,553; p=0,018).Conclusion. The EXCEL study demonstrated a stable favorable effect of EECP in patients with HF complicated by CAD on clinical indicators and outcomes, which were significantly more pronounced in the group with 2 courses of EECP (70 hours) per year compared to a single annual course.

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Possibilities of Enhanced External Counterpulsation Using in Clinical Practice

Cited by 6 publications

References 37 publications

Medium-term Effects of Enhanced External Counterpulsation in the Structural and Functional Parameters of Blood Vessels in Patients with Coronary Artery Disease

Medium-term Effects of Enhanced External Counterpulsation in the Structural and Functional Parameters of Blood Vessels in Patients with Coronary Artery Disease

A multimorbid patient with heart failure and long-term treatment with enhanced external counterpulsation: a case report

Enhanced external counterpulsation in the management of patients with ischemic heart failure: long-term impact on clinical outcomes

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