Enhanced External Counterpulsation Increases Coronary Flow Reserve in Coronary Microvascular Disease

Overview

Journal Saudi Med J

Specialty General Medicine

Date 2023 Nov 28

PMID 38016747

Authors

Qian Wang

Jia Hao

Wenjun Jiang

Qiang Tan

Affiliations

Soon will be listed here.

Abstract

Objectives: To investigates the outcomes of enhanced external counterpulsation (EECP) among coronary microvascular disease (CMD) patients.

Methods: Coronary microvascular disease patients were separated into the EECP (n=41) and control cohorts (n=42). Prior to and following the 4-week EECP program, coronary flow reserve (CFR) was recorded using transthoracic Doppler echocardiography. The serum endothelial nitric oxide synthase (eNOS) and endothelin-1 (ET-1) contents were analyzed by ELISA. Quality of life (QoL) was assessed by the Seattle Angina Questionnaire (SAQ) and the Canadian Cardiovascular Society (CCS) angina class.

Results: After four weeks, CFR was substantially enhanced in the EECP versus control cohort (<0.05). Endothelin-1 was strongly diminished whereas eNOS was considerably upregulated in the EECP cohort. EECP also enhanced patients' SAQ scores and decreased the CCS angina class.

Conclusion: Enhanced external counterpulsation may improve CFR and enhance the CMD patient QoL.

Citing Articles

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References

Tagliamonte E, Cirillo T, Rigo F, Astarita C, Coppola A, Romano C . Ivabradine and Bisoprolol on Doppler-derived Coronary Flow Velocity Reserve in Patients with Stable Coronary Artery Disease: Beyond the Heart Rate. Adv Ther. 2015; 32(8):757-67. PMC: 4569671. DOI: 10.1007/s12325-015-0237-x. View

Sinha A, Rahman H, Perera D . Coronary microvascular disease: current concepts of pathophysiology, diagnosis and management. Cardiovasc Endocrinol Metab. 2021; 10(1):22-30. PMC: 7901821. DOI: 10.1097/XCE.0000000000000223. View

Taqueti V, Solomon S, Shah A, Desai A, Groarke J, Osborne M . Coronary microvascular dysfunction and future risk of heart failure with preserved ejection fraction. Eur Heart J. 2018; 39(10):840-849. PMC: 5939665. DOI: 10.1093/eurheartj/ehx721. View

Ford T, Ong P, Sechtem U, Beltrame J, Camici P, Crea F . Assessment of Vascular Dysfunction in Patients Without Obstructive Coronary Artery Disease: Why, How, and When. JACC Cardiovasc Interv. 2020; 13(16):1847-1864. PMC: 7447977. DOI: 10.1016/j.jcin.2020.05.052. View

Ford T, Stanley B, Good R, Rocchiccioli P, McEntegart M, Watkins S . Stratified Medical Therapy Using Invasive Coronary Function Testing in Angina: The CorMicA Trial. J Am Coll Cardiol. 2018; 72(23 Pt A):2841-2855. DOI: 10.1016/j.jacc.2018.09.006. View

Zhang Y, Chen Z, Mai Z, Zhou W, Wang H, Zhang X . Acute Hemodynamic Responses to Enhanced External Counterpulsation in Patients With Coronary Artery Disease. Front Cardiovasc Med. 2021; 8:721140. PMC: 8632772. DOI: 10.3389/fcvm.2021.721140. View

Chen C, Wei J, AlBadri A, Zarrini P, Merz C . Coronary Microvascular Dysfunction　- Epidemiology, Pathogenesis, Prognosis, Diagnosis, Risk Factors and Therapy. Circ J. 2016; 81(1):3-11. PMC: 8607842. DOI: 10.1253/circj.CJ-16-1002. View

Taqueti V, Di Carli M . Coronary Microvascular Disease Pathogenic Mechanisms and Therapeutic Options: JACC State-of-the-Art Review. J Am Coll Cardiol. 2018; 72(21):2625-2641. PMC: 6296779. DOI: 10.1016/j.jacc.2018.09.042. View

Ong P, Camici P, Beltrame J, Crea F, Shimokawa H, Sechtem U . International standardization of diagnostic criteria for microvascular angina. Int J Cardiol. 2017; 250:16-20. DOI: 10.1016/j.ijcard.2017.08.068. View

10.

Sara J, Widmer R, Matsuzawa Y, Lennon R, Lerman L, Lerman A . Prevalence of Coronary Microvascular Dysfunction Among Patients With Chest Pain and Nonobstructive Coronary Artery Disease. JACC Cardiovasc Interv. 2015; 8(11):1445-1453. DOI: 10.1016/j.jcin.2015.06.017. View

11.

Jan R, Khan A, Zahid S, Sami A, Owais S, Khan F . The Effect of Enhanced External Counterpulsation (EECP) on Quality of life in Patient with Coronary Artery Disease not Amenable to PCI or CABG. Cureus. 2020; 12(5):e7987. PMC: 7273423. DOI: 10.7759/cureus.7987. View

12.

Jurs A, Pedersen L, Olsen R, Snoer M, Chabanova E, Haugaard S . Coronary microvascular function, insulin sensitivity and body composition in predicting exercise capacity in overweight patients with coronary artery disease. BMC Cardiovasc Disord. 2015; 15:159. PMC: 4661957. DOI: 10.1186/s12872-015-0151-9. View

13.

Du F, Zhang W, Mao H, Guo Y, Guo M, Lu Y . The Effect of Long-Term External Counterpulsation Combined with Exercise Therapy on the Establishment of Collateral Circulation in Patients with Coronary Artery Occlusive Disease. Biomed Res Int. 2022; 2022:1336184. PMC: 9020965. DOI: 10.1155/2022/1336184. View

14.

Thakker R, Rodriguez Lozano J, Rodriguez Lozano P, Motiwala A, Rangasetty U, Khalife W . Coronary Microvascular Disease. Cardiol Ther. 2022; 11(1):23-31. PMC: 8933600. DOI: 10.1007/s40119-021-00250-6. View

15.

Yang H, Song L, Ning X, Ma Y, Xue A, Zhao H . Enhanced external counterpulsation ameliorates endothelial dysfunction and elevates exercise tolerance in patients with coronary artery disease. Front Cardiovasc Med. 2022; 9:997109. PMC: 9744945. DOI: 10.3389/fcvm.2022.997109. View

16.

Qin X, Deng Y, Wu D, Yu L, Huang R . Does Enhanced External Counterpulsation (EECP) Significantly Affect Myocardial Perfusion?: A Systematic Review & Meta-Analysis. PLoS One. 2016; 11(4):e0151822. PMC: 4821484. DOI: 10.1371/journal.pone.0151822. View

17.

Bradley C, Berry C . Definition and epidemiology of coronary microvascular disease. J Nucl Cardiol. 2022; 29(4):1763-1775. PMC: 9345825. DOI: 10.1007/s12350-022-02974-x. View

18.

Lawton J, Tamis-Holland J, Bangalore S, Bates E, Beckie T, Bischoff J . 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021; 145(3):e4-e17. DOI: 10.1161/CIR.0000000000001039. View