The effect of external counterpulsation on intrinsic myocardial function evaluated by speckle tracking echocardiography in refractory angina patients: a randomized controlled trial

Pravian, Dexanda; Soesanto, Amiliana M.; Ambari, Ade Meidian; Kuncoro, B. R. M. Ario S.; Dwiputra, Bambang; Muliawan, Hary Sakti; Sukmawan, Renan

doi:10.1007/s10554-021-02289-x

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…However, further studies are needed to evaluate whether improvement in angiogenesis marker will be sustained in the long term after completion of ECP and its relation to the clinical outcome. A sub-analysis study from Pravian et al ( 50 ) has shown that although ECP did not improve left ventricular (LV) longitudinal strain globally or segmentally, there was an improvement in segments with post-systolic shortening (PSS) which indicates improvement in myocardial perfusion.…”

Section: Discussionmentioning

confidence: 99%

External Counterpulsation Improves Angiogenesis by Preserving Vascular Endothelial Growth Factor-A and Vascular Endothelial Growth Factor Receptor-2 but Not Regulating MicroRNA-92a Expression in Patients With Refractory Angina

Ambari

Lilihata

Zuhri

et al. 2021

Front. Cardiovasc. Med.

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Objective: External counterpulsation (ECP) provides long-term benefits of improved anginal frequency and exercise tolerance in patients with refractory angina (RA). This is postulated as a result of improved angiogenesis and endothelial function through an increase in shear stress. Angiogenesis is mainly represented by vascular endothelial growth factor-A (VEGF-A) and its receptor, vascular endothelial growth factor receptor-2 (VEGFR-2). The microRNA-92a (miR-92a) is a flow-sensitive miRNA that regulates atherosclerosis and angiogenesis in response to shear stress. Thus, ECP beneficial effect might be achieved through interaction between VEGF-A, VEGFR-2, and miR-92a. This study aims to evaluate the ECP effect on VEGF-A, VEGFR-2, and miR-92a in patients with RA in a sham-controlled manner.Methods: This was a randomized sham-controlled trial, enrolling 50 patients with RA who have coronary artery disease (CAD). Participants were randomized (1:1 ratio) to 35 sessions of either ECP (n = 25) or sham (n = 25), each session lasting for 1 h. Plasma levels of VEGF-A and VEGFR-2 were assayed by the ELISA technique. The quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was performed to measure miR-92a circulating levels in plasma.Result: External counterpulsation significantly preserved VEGF-A and VEGFR-2 level compared to sham [ΔVEGF-A: 1 (−139 to 160) vs.−136 (−237 to 67) pg/ml, p = 0.026; ΔVEGFR-2: −171(-844 to +1,166) vs. −517(−1,549 to +1,407) pg/ml, p = 0.021, respectively]. Circulating miR-92a increased significantly in ECP [5.1 (4.2–6.4) to 5.9 (4.8–6.4), p < 0.001] and sham [5.2 (4.1–9.4) to 5.6 (4.8–6.3), p = 0.008] post-intervention. The fold changes tended to be higher in ECP group, although was not statistically different from sham [fold changes ECP = 4.6 (0.3–36.5) vs. sham 2.8 (0–15), p = 0.33)].Conclusion: External counterpulsation improved angiogenesis by preserving VEGF-A and VEGFR-2 levels. Both ECP and sham increased miR-92a significantly, yet the changes were not different between the two groups. (Study registered on www.clinicaltrials.gov, no: NCT03991871, August 8, 2019, and received a grant from the National Health Research and Development of Ministry of Health of Indonesia, No: HK.02.02/I/27/2020).

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Section: Discussionmentioning

confidence: 99%

External Counterpulsation Improves Angiogenesis by Preserving Vascular Endothelial Growth Factor-A and Vascular Endothelial Growth Factor Receptor-2 but Not Regulating MicroRNA-92a Expression in Patients With Refractory Angina

Ambari

Lilihata

Zuhri

et al. 2021

Front. Cardiovasc. Med.

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“…In the present issue of the International Journal of Cardiovascular Imaging [14], Pravian et al assessed 43 patients with refractory angina who could not be revascularized conventionally. They were randomized into two groups, the External Counterpulsation (ECP) group and the Sham/control group.…”

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confidence: 99%

Myocardial strain and refractory angina: an intriguing puzzle

Vitarelli

2021

Int J Cardiovasc Imaging

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Research focus and theme evolution on enhanced external counterpulsation: A bibliometric analysis

Yang,

Lu,

Cheng

et al. 2025

Heliyon

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The effect of external counterpulsation on intrinsic myocardial function evaluated by speckle tracking echocardiography in refractory angina patients: a randomized controlled trial

Cited by 3 publications

References 19 publications

External Counterpulsation Improves Angiogenesis by Preserving Vascular Endothelial Growth Factor-A and Vascular Endothelial Growth Factor Receptor-2 but Not Regulating MicroRNA-92a Expression in Patients With Refractory Angina

External Counterpulsation Improves Angiogenesis by Preserving Vascular Endothelial Growth Factor-A and Vascular Endothelial Growth Factor Receptor-2 but Not Regulating MicroRNA-92a Expression in Patients With Refractory Angina

Myocardial strain and refractory angina: an intriguing puzzle

Research focus and theme evolution on enhanced external counterpulsation: A bibliometric analysis

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