Enhanced external counterpulsation treatment improves arterial wall properties and wave reflection characteristics in patients with refractory angina.
نویسندگان
چکیده
OBJECTIVES To determine if arterial properties and wave reflection characteristics are favorably altered after enhanced external counterpulsation (EECP) treatment in patients with refractory angina. BACKGROUND Early return of reflected waves from the lower body, resulting from increased arterial stiffness, augments central aortic pressure and increases left ventricular (LV) afterload and myocardial oxygen demand. EECP acutely enhances coronary perfusion (supply) and reduces LV afterload (demand). However, the mechanisms responsible for the sustained beneficial effects of EECP treatment are unclear. METHODS Radial artery pressure waveforms were recorded by applanation tonometry and central aortic pressure waveforms generated using a mathematical transfer function in 20 patients with stable refractory angina. Data were collected before and after 34 1-h EECP sessions. Augmentation index (AI(a)) and timing of the reflected pressure wave were calculated from the aortic waveform. RESULTS EECP treatment caused a decline in AI(a) and an increase in reflected wave travel time. These modifications in wave reflection characteristics caused a decrease in aortic systolic pressure and wasted LV pressure energy. The average number of angina episodes and Canadian Cardiovascular Society (CCS) class, both decreased in concordance with the physiologic changes due to EECP treatment. CONCLUSIONS EECP treatment reduces arterial stiffness and improves wave reflection characteristics in patients with refractory angina. These changes decrease LV afterload and myocardial oxygen demand and reduce the number of angina episodes, therefore enabling patients to participate in continuous exercise programs which in turn may provide long-term benefits and sustained improved quality of life.
منابع مشابه
اثرات درمانی فشارنده متناوب تقویت شده خارجی (EECP) در آنژین قلبی مقاوم به درمان در بیماران نامناسب برای اقدامات تهاجمی
Background & Aims: Enhanced external counterpulsation (EECP) is a non-invasive outpatient treatment used for angina pectoris. In patients with intractable angina who were symptomatic after medical and invasive strategies, several novel techniques are considered including EECP. In patients with refractory angina due to coronary anatomy specific information, CABG or PCI are also up despite anti-...
متن کاملTreatment options for refractory angina pectoris: enhanced external counterpulsation therapy.
Refractory angina pectoris, defined as angina refractory to maximal medical therapy and standard coronary revascularization procedures, remains a significant health problem in the United States and the world. Despite a panoply of recent therapeutic advances, patients with refractory angina pectoris are not adequately treated; therefore, scientists have been investigating new technologies to hel...
متن کاملEffect of Enhanced External Counterpulsation (EECP) on Exercise Time Duration and Functional Capacity in Patients with Refractory Angina Pectoris
BACKGROUND Enhanced external counterpulsation (EECP) is a noninvasive technique used for patients with refractory angina pectoris. There are controversial data on the effectiveness of EECP in improving patients with refractory stable angina. The aim of the present study was to evaluate the effectiveness and safety of EECP for the treatment of patients with refractory angina pectoris. METHODS ...
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INTRODUCTION Enhanced external counterpulsation (EECP) is a noninvasive circulatory assist device that has been recently emerged as a treatment option for refractory angina or left ventricular (LV) dysfunction. The aims of this study were to examine the effects of EECP on the elecrocardiographic parameters and the heart rate variability indices of patients with the coronary heart disease and fu...
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Enhanced external counterpulsation (EECP) is a non-invasive outpatient treatment used for angina pectoris. In patients with intractable angina refractory to aggressive surgical and medical treatment, several novel strategies are considered including EECP, transmural laser revascularisation, and spinal cord stimulation. EECP produces an acute haemodynamic effect that is presumed to be similar to...
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ورودعنوان ژورنال:
- Journal of the American College of Cardiology
دوره 48 6 شماره
صفحات -
تاریخ انتشار 2006