1
|
Zhou ZF, Wang DJ, Li XM, Zhang CL, Wu CY. Effects of enhanced external counterpulsation on exercise capacity and quality of life in patients with chronic heart failure: A meta-analysis. Medicine (Baltimore) 2021; 100:e26536. [PMID: 34232191 PMCID: PMC8270628 DOI: 10.1097/md.0000000000026536] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/15/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND This meta-analysis aimed to synthesize randomized controlled trials to evaluate the effects of enhanced external counterpulsation (EECP) on exercise capacity and quality of life in patients with chronic heart failure (CHF). METHODS Both English and Chinese databases were searched from their inception to June 30, 2020 (PubMed, EMBASE, Cochrane Library, CINAHL (EBSCO), Web of Science for English publications and Chinese Biomedical Database, China National Knowledge Infrastructure, Wanfang Data for Chinese publication). Titles, abstracts, and full-text articles were screened against study inclusion criteria: randomized controlled trials studying EECP intervention for patients with CHF. The meta-analysis was conducted with Revman 5.3 or STATA 16.0. RESULTS Eight randomized controlled trials were included. EECP induced significant improvement in 6-min walking distance (WMD=84.79 m; 95% CI, 47.64 to 121.95; P < .00001). Moreover, EECP was beneficial for left ventricular ejection fraction (SMD = 0.64; 95% CI,0.29 to 1.00; P = .0004), and N-terminal pro brain natriuretic peptide (SMD = -0.61; 95%CI, -1.20 to -0.01; P = 0.04).However, compared with the control groups, EECP did not significantly reduce the Minnesota Living with Heart Failure Questionnaire scores(WMD, -9.28; 95% CI, -19.30 to 0.75; P = 0.07). CONCLUSIONS Despite heterogeneity and risk of bias, this meta-analysis confirms that EECP can improve exercise capacity in CHF patients, especially the elderly. However, the evidence that EECP improves the quality of life in patients with CHF is still insufficient. More and larger well-designed randomized controlled trials are still warranted. REGISTRATION INFORMATION PROSPERO registration no. CRD 42020188848.
Collapse
|
2
|
Caceres J, Atal P, Arora R, Yee D. Enhanced external counterpulsation: A unique treatment for the "No-Option" refractory angina patient. J Clin Pharm Ther 2021; 46:295-303. [PMID: 33410549 PMCID: PMC7986429 DOI: 10.1111/jcpt.13330] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 12/21/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES Coronary artery disease (CAD) is the leading cause of death in the United States. For patients on whom guideline-driven measures have been tried, enhanced external counterpulsation (EECP) is the only truly noninvasive and safe intervention for which a reduction of angina symptoms and nitrate use, increased exercise tolerance, and improvement in myocardial ischaemia have been shown. The objective of this study was to demonstrate, by way of literature review, the efficacy of EECP as a treatment modality for the relief of refractory angina and improvement in quality of life in CAD patients. METHODS This article reviewed the safety and efficacy of EECP in patients with refractory angina, by conducting a sweeping search and analysis of existing published literature. RESULTS AND DISCUSSION Critical review of a multitude of studies revealed that EECP consistently reduces angina pectoris, extends time to exercise-induced ischaemia, decreases dependency on nitroglycerine for frequent chest pain, increases maximum workload, and improves the quality of life in patients with symptomatic stable angina. The literature reviewed also indicated that EECP is well-tolerated by the vast majority of patients, with relatively few adverse events reported. CONCLUSION The present study suggests that EECP is a safe and likely best available method of treatment for patients presenting with symptomatic CAD not amenable to further revascularization.
Collapse
Affiliation(s)
- Jose Caceres
- Buena Park Heart Center8585 Knott Ave, #101Buena ParkCA90620USA
| | - Patricia Atal
- Buena Park Heart Center8585 Knott Ave, #101Buena ParkCA90620USA
| | - Rohit Arora
- Campbell University School of Medicine4350 US‐421LillingtonNC27546USA
| | - Derek Yee
- Buena Park Heart Center8585 Knott Ave, #101Buena ParkCA90620USA
| |
Collapse
|
3
|
Mendoza F, Jaramillo C, Poveda M, Gómez E, Martínez S, Canro AF. Contrapulsación externa aumentada, un tratamiento no invasivo recomendado para la angina refractaria, valoración de la clase funcional y la calidad de vida. REVISTA COLOMBIANA DE CARDIOLOGÍA 2017. [DOI: 10.1016/j.rccar.2016.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
4
|
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:e0151822. [PMID: 27045935 PMCID: PMC4821484 DOI: 10.1371/journal.pone.0151822] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 03/04/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Enhanced external counterpulsation (EECP) is currently applied for treating coronary artery disease (CAD) patients. However, the mechanism(s) by which EECP ameliorates angina pectoris and long-term left ventricular function remain largely unknown. The aim of this study will be to assess whether EECP significantly affects myocardial perfusion in CAD patients through a systematic review and meta-analysis of the available literature. METHODS MEDLINE, EMBASE, and Cochrane CENTRAL databases were searched for prospective studies on CAD patients that underwent EECP and reported myocardial perfusion data pre- and post-EECP. The impact of EECP was assessed based on the weighted mean difference (WMD) in myocardial perfusion from pre-EECP to post-EECP. Statistical heterogeneity was assessed by the I2 index. Publication bias was assessed through visual inspection of the funnel plot as well as Begg's and Egger's testing. RESULTS Standard EECP therapy (i.e., 35-36 one-hour sessions within a seven-week period) significantly increased myocardial perfusion in CAD patients (pooled WMD: -0.19, 95% CI: -0.38 to 0.00, p = 0.049). A random effects analysis was applied on account of significant heterogeneity (I2 = 89.1%, p = 0.000). There was no evidence of significant publication bias (Begg's p = 0.091; Egger's p = 0.282). CONCLUSIONS Standard EECP therapy significantly increases myocardial perfusion in CAD patients. This study's findings support the continued use of standard EECP therapy in CAD patients and provides one putative physiological mechanism to help explain the improvements in angina pectoris and long-term left ventricular function observed in CAD patients after EECP therapy.
Collapse
Affiliation(s)
- Xiaoxia Qin
- Department of Rehabilitation Medicine, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yanye Deng
- Department of Rehabilitation Medicine, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dandong Wu
- Department of Rehabilitation Medicine, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lehua Yu
- Department of Rehabilitation Medicine, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- * E-mail: (RH); (LY)
| | - Rongzhong Huang
- Department of Rehabilitation Medicine, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- * E-mail: (RH); (LY)
| |
Collapse
|
5
|
|
6
|
Zhang C, Liu X, Wang X, Wang Q, Zhang Y, Ge Z. Efficacy of Enhanced External Counterpulsation in Patients With Chronic Refractory Angina on Canadian Cardiovascular Society (CCS) Angina Class: An Updated Meta-Analysis. Medicine (Baltimore) 2015; 94:e2002. [PMID: 26632696 PMCID: PMC5058965 DOI: 10.1097/md.0000000000002002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A growing number of patients with chronic artery disease suffer from angina, despite the optimal medical management (ie, β-blockers, calcium channel blockers, and long-acting nitrates) and revascularization. Currently, enhanced external counterpulsation (EECP) therapy has been verified as a noninvasive, safe therapy for refractory angina. The study was designed to evaluate the efficacy of EECP in patients with chronic refractory angina according to Canadian Cardiovascular Society (CCS) angina class.We identified systematic literature through MEDLINE, EMBASE, the Cochrane Clinical Trials Register Database, and the ClinicalTrials. gov Website from 1990 to 2015. Studies were considered eligible if they were prospective and reported data on CCS class before and after EECP treatment. Meta-analysis was performed to assess the efficacy of EECP therapy by at least 1 CCS angina class improvement, and proportion along with the 95% confidence interval (CI) was calculated. Statistical heterogeneity was calculated by I statistic and the Q statistic. Sensitivity analysis was addressed to test the influence of trials on the overall pooled results. Subgroup analysis was applied to explore potential reasons for heterogeneity.Eighteen studies were enrolled in our meta-analysis. Pooled analysis showed 85% of patients underwent EECP had a reduction by at least one CCS class (95%CI 0.81-0.88, I = 58.5%, P < 0.001). The proportion of patients enrolled at primarily different studies with chronic heart failure (CHF) improved by at least 1 CCS class was about 84% after EECP (95%CI 0.81-0.88, I = 32.7%, P = 0.1668). After 3 large studies were excluded, the pooled proportion was 82% (95%CI 0.79-0.86, I = 18%, P = 0.2528). Funnel plot indicated that some asymmetry while the Begg and Egger bias statistic showed no publication bias (P = 0.1495 and 0.2859, respectively).Our study confirmed that EECP provided an effective treatment for patients who were unresponsive to medical management and/or invasive therapy. However, the long-term benefits of EECP therapy needed further studies to evaluate in the management of chronic refractory angina.
Collapse
Affiliation(s)
- Chunmei Zhang
- From the Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | | | | | | | | | | |
Collapse
|
7
|
Soran O. Alternative therapy for medically refractory angina: enhanced external counterpulsation and transmyocardial laser revascularization. Cardiol Clin 2015; 32:429-38. [PMID: 25091968 DOI: 10.1016/j.ccl.2014.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Medically refractory angina pectoris (RAP) is defined by presence of severe angina with objective evidence of ischemia and failure to relieve symptoms with coronary revascularization. Medication and invasive revascularization are the most common approaches for treating coronary artery disease (CAD). Although symptoms are eliminated or alleviated by these invasive approaches, the disease and its causes are present after treatment. New treatment approaches are needed to prevent the disease from progressing and symptoms from recurring. External enhanced counterpulsation therapy provides a treatment modality in the management of CAD and can complement invasive revascularization procedures. Data support that it should be considered a first-line treatment of RAP.
Collapse
Affiliation(s)
- Ozlem Soran
- Heart and Vascular Institute, University of Pittsburgh, 200 Lothrop Street, Scaife Hall S-623, Pittsburgh, PA 15213, USA.
| |
Collapse
|
8
|
Xiong Y, Ren YF, Xu J, Yang DY, He XH, Luo JY, Rana JS, Zhang Y, Zheng ZS, Liu DH, Wu GF. Enhanced external counterpulsation inhibits endothelial apoptosis via modulation of BIRC2 and Apaf-1 genes in porcine hypercholesterolemia. Int J Cardiol 2013; 171:161-8. [PMID: 24380498 DOI: 10.1016/j.ijcard.2013.11.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 10/17/2013] [Accepted: 11/17/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Enhanced external counterpulsation (EECP) could improve endothelium-dependent vasodilatation of carotid artery and restore imbalance of nitric oxide and endothein-1 in patients with coronary artery disease. Our study was designed to test the hypothesis that long-term EECP may protect vascular endothelial cells from apoptosis by modifying apoptosis-related gene expression. METHODS Eighteen male Yorkshire pigs were randomly assigned to three groups: usual diet (Normal), high cholesterol diet (HC) and high cholesterol diet plus EECP (HC+EECP). Vascular endothelial cells were isolated from the aortic endothelium and identified by CD31 staining and DiI-Ac-LDL reaction. Morphological changes were observed by both scanning and transmission electronic microscopes. TUNEL technique was applied to detect the apoptotic index of vascular endothelial cells. Two genes, Apaf-1 and BIRC2, were chosen for exploring the potential mechanisms of action at the molecular level. RESULTS EECP brought a certain degree of alleviation from ultrastructural changes such as shrinking and blebbing of cytomembrane, marginalization, degeneration, and fragmentation of the nucleus. EECP also significantly reduced apoptotic indices while compared with that of control (177±12‰ vs. 237±23‰, P<0.05). The Apaf-1 expression at both protein and mRNA level in pigs of HC+EECP group was significantly decreased than those of the HC group (P<0.05), whereas the BIRC2 expression was significantly enhanced after EECP treatment, documented by immunostaining and semi-quantitative RT-PCR analysis, respectively (P<0.05). CONCLUSIONS EECP could protect vascular endothelial cells from apoptosis, thereby delaying the progression of early atherosclerotic lesions possibly through transcriptional down-regulation of pro-apoptotic gene Apaf-1, and up-regulation of anti-apoptotic gene BIRC2.
Collapse
Affiliation(s)
- Yan Xiong
- The Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, 510080 China; Division of Emergency Medicine, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080 China
| | - Yu-Feng Ren
- Division of Radiological Therapy, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080 China
| | - Jia Xu
- The Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, 510080 China; Division of Emergency Medicine, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080 China
| | - Da-Ya Yang
- The Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, 510080 China; Division of Cardiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080 China
| | - Xiao-Hong He
- The Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, 510080 China
| | - Jing-Yun Luo
- The Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, 510080 China; Division of Cardiology, Guangzhou Red Cross Hospital, Guangzhou, 510220 China
| | - Jamal S Rana
- Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yan Zhang
- The Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, 510080 China; Division of Cardiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080 China
| | - Zhen-Sheng Zheng
- The Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, 510080 China; Division of Cardiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080 China
| | - Dong-Hong Liu
- The Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, 510080 China; Division of Ultrasound, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080 China
| | - Gui-Fu Wu
- The Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, 510080 China; Division of Cardiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080 China; Heart Center, The Affiliated Futian Hospital of Guangdong Medical College, Shenzhen, 518033 China.
| |
Collapse
|
9
|
Yang Y, Zhang H, Yan Y, Gui Y. Clinical study in patients with ocular ischemic diseases treated with enhanced external counterpulsation combined with drugs. Mol Med Rep 2013; 7:1845-9. [PMID: 23625058 DOI: 10.3892/mmr.2013.1445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 04/20/2013] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was to evaluate the clinical effect in patients with ocular ischemic diseases treated with enhanced external counterpulsation (EECP) combined with drugs. A total of 65 patients with carotid artery stenosis were included in this study. Group A consisted of 31 patients (43 eyes) treated with EECP and medication, and group B consisted of 34 patients (49 eyes) treated with medication alone. The clinical effect was analyzed by comparing the visual acuity, visual fields and optical hemodynamics between the two groups of patients. Ocular ischemic diseases mainly included ischemic optic neuropathy, central (branch) retinal artery occlusion, ophthalmoplegia externa and ocular ischemic syndrome. Significant improvement of visual acuity, visual fields and optical hemodynamics was observed in the patients of group A, and statistically significant differences were found between groups A and B (χ2=4.935, 7.124 and 5.478, respectively; P<0.05). In conclusion, ophthalmologists should observe for ocular ischemic diseases. The symptoms of the disease and the vision of the patient could be effectively improved by EECP, which has no evident complications.
Collapse
Affiliation(s)
- Yuxin Yang
- Department of Ophthalmology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan 453100, P.R. China.
| | | | | | | |
Collapse
|
10
|
Wu E, Mårtensson J, Broström A. Enhanced external counterpulsation in patients with refractory angina pectoris: a pilot study with six months follow-up regarding physical capacity and health-related quality of life. Eur J Cardiovasc Nurs 2012; 12:437-45. [DOI: 10.1177/1474515112468067] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Eline Wu
- Department of Cardiology M82, Karolinska University Hospital, Sweden
| | | | | |
Collapse
|
11
|
Enhanced external counterpulsation: A novel therapy for angina. Complement Ther Clin Pract 2012; 18:197-203. [DOI: 10.1016/j.ctcp.2012.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 06/20/2012] [Indexed: 11/23/2022]
|
12
|
Braverman DL, Braitman L, Figueredo VM, Figeuredo VM. The safety and efficacy of enhanced external counterpulsation as a treatment for angina in patients with aortic stenosis. Clin Cardiol 2012; 36:82-7. [PMID: 23109041 DOI: 10.1002/clc.22073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 09/30/2012] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Comorbid aortic stenosis (AS) has been considered a precaution when applying enhanced external counterpulsation (EECP) to individuals with angina due to concerns about treatment-related hemodynamic changes. HYPOTHESIS The aim of this study was to determine whether EECP safely reduces symptoms of myocardial ischemia and improves hemodynamics in individuals with AS. METHODS Forty-three patients with AS (average age, 73 years; 86% male) and 43 comparison patients without AS were chosen from a database of 1327 EECP patients. Canadian Cardiovascular Society (CCS) Functional Angina Classification, diastolic augmentation ratio, and blood pressure were measured at baseline and on completion of the course of EECP. RESULTS Thirty-five of the 43 patients with AS (81%, 95% CI: 66.6% to 91.6%) and 38 of the 43 without AS (88%, 95% CI: 74.9% to 96.1%) improved in angina class (P < 0.0001). There was no statistical difference between the percentages in patients with and without AS (P = 0.54). CCS angina class outcome was not associated with AS severity (P = 0.55). The percentage of patients with diastolic augmentation ratio ≥1.0 was 16.3% in both groups at baseline and improved to 39.5% in AS patients and 37.2% in non-AS patients after EECP (both P = 0.002). The average decreases in systolic blood pressure in subjects with AS (-15 mm Hg, 95% CI: 11 to 20, P < 0.0001) and without AS (-18 mm Hg, 95% CI: 14 to 22, P < 0.0001) were similar (P = 0.31). No major adverse cardiac events were reported. CONCLUSIONS Angina patients with AS who undergo EECP had clinically important symptomatic and hemodynamic improvements comparable to their non-AS counterparts.
Collapse
Affiliation(s)
- Debra L Braverman
- Division of Cardiology, Einstein Institute for Heart and Vascular Health, Albert Einstein Medical Center, Philadelphia, PA, USA.
| | | | | | | |
Collapse
|
13
|
Jenkins NT, Martin JS, Laughlin MH, Padilla J. Exercise-induced Signals for Vascular Endothelial Adaptations: Implications for Cardiovascular Disease. CURRENT CARDIOVASCULAR RISK REPORTS 2012; 6:331-346. [PMID: 22844545 PMCID: PMC3404842 DOI: 10.1007/s12170-012-0241-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This article reviews recent advances in our understanding of hemodynamic signals, external/compressive forces, and circulating factors that mediate exercise training-induced vascular adaptations, with particular attention to the roles of these signals in prevention and treatment of endothelial dysfunction and cardiovascular (CV) diseases.
Collapse
Affiliation(s)
| | | | - M. Harold Laughlin
- Biomedical Sciences, University of Missouri, Columbia, MO
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO
- Medical Pharmacology and Physiology, University of Missouri, Columbia, MO
| | - Jaume Padilla
- Biomedical Sciences, University of Missouri, Columbia, MO
| |
Collapse
|
14
|
Braverman DL. Enhanced external counterpulsation: an innovative physical therapy for refractory angina. PM R 2009; 1:268-76. [PMID: 19627906 DOI: 10.1016/j.pmrj.2008.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Revised: 12/03/2008] [Accepted: 12/04/2008] [Indexed: 11/19/2022]
Abstract
The prevalence of refractory angina in the United States is 600,000 to 1.8 million. Improved pharmacological, invasive, and surgical therapies for cardiovascular diseases during the last few decades have led to an increase in life expectancy of such individuals. Despite treatment with multiple medications and invasive procedures, these patients remain symptomatic and functionally limited. Enhanced external counterpulsation (EECP) is a safe, noninvasive, well-tolerated, and clinically effective outpatient physical therapy for many patients with refractory angina. Numerous trials demonstrate positive clinical responses among at least 80% of patients undergoing EECP, including reductions in angina and nitrate use, increases in exercise tolerance, and enhanced quality of life. Several mechanisms, including the promotion of collateral blood flow, improvement in endothelial function, reduction in inflammation, and the production of peripheral training effects similar to exercise, are thought to be responsible for the clinical benefits of this therapy. Despite the marked success rates EECP achieves with appropriately selected patients who have end-stage coronary artery disease, the treatment remains largely unknown, particularly among physiatrists. This review will summarize the current evidence for the use of EECP and spark a better understanding of the potential role of this treatment in cardiac rehabilitation.
Collapse
|
15
|
Soran O. Treatment options for refractory angina pectoris: Enhanced external counterpulsation therapy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2009; 11:54-60. [DOI: 10.1007/s11936-009-0006-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
16
|
Manchanda A, Soran O. Enhanced External Counterpulsation and Future Directions. J Am Coll Cardiol 2007; 50:1523-31. [DOI: 10.1016/j.jacc.2007.07.024] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Revised: 05/25/2007] [Accepted: 07/17/2007] [Indexed: 12/01/2022]
|
17
|
Estahbanaty G, Samiei N, Maleki M, Noohi F, Mohebi A, Ojaghi Z, Esmaeilzadeh M, Sadeghpour A, Soran O. Echocardiographic Characteristics Including Tissue Doppler Imaging After Enhanced External Counterpulsation Therapy. ACTA ACUST UNITED AC 2007; 5:241-6. [DOI: 10.1111/j.1541-9215.2007.06599.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
18
|
Michaels AD, McCullough PA, Soran OZ, Lawson WE, Barsness GW, Henry TD, Linnemeier G, Ochoa A, Kelsey SF, Kennard ED. Primer: practical approach to the selection of patients for and application of EECP. ACTA ACUST UNITED AC 2006; 3:623-32. [PMID: 17063167 DOI: 10.1038/ncpcardio0691] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2006] [Accepted: 07/26/2006] [Indexed: 11/09/2022]
Abstract
Over the past decade, the frequency of use of enhanced external counterpulsation (EECP) has increased in patients with angina, irrespective of medical therapy and coronary revascularization status. Many patients referred for EECP have one or more comorbidities that could affect this treatment's efficacy, safety, or both. By use of data from more than 8,000 patients enrolled in the International EECP Patient Registry, we provide practical guidelines for the selection and treatment of patients. We have focused on considerations for patients who have one or more of the following characteristics: age older than 75 years, diabetes, obesity, heart failure, and peripheral vascular disease. We have also reviewed outcomes and treatment recommendations for individuals with poor diastolic augmentation during treatment, for those with atrial fibrillation or pacemakers, and for those receiving anticoagulation therapy. Lastly, we examined relevant data regarding extended courses of EECP, repeat therapy, or both. While clinical studies have demonstrated the usefulness of EECP in selected patients, these guidelines permit recommendations for the extended application of this important treatment to subsets of patients excluded from clinical trials.
Collapse
Affiliation(s)
- Andrew D Michaels
- Division of Cardiology, University of Utah, Room 4A100, 30 North 1900 East, Salt Lake City, UT 84132-2401, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|