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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

https://doi.org/10.20996/1819-6446-2021-08-03

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Abstract

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.

About the Authors

K. S. Karaganov
I.M. Sechenov First Moscow State Medical University
Russian Federation

Kirill S. Karaganov

Moscow



O. A. Slepova
I.M. Sechenov First Moscow State Medical University
Russian Federation

Olga A. Slepova

Moscow



A. S. Lishuta
I.M. Sechenov First Moscow State Medical University
Russian Federation

Alexey S. Lishuta

eLibrary SPIN 4365-4788

Moscow



N. I. Solomakhina
I.M. Sechenov First Moscow State Medical University
Russian Federation

Nina I. Solomakhina

Moscow



Yu. N. Belenkov
I.M. Sechenov First Moscow State Medical University
Russian Federation

Yuri N. Belenkov

Moscow

 



References

1. Benjamin E.J., Muntner P., Alonso A., et al. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019;139(10):e56-e528. DOI:10.1161/CIR.0000000000000659.

2. Niimi N, Sawano M, Ikemura N, et al. Applicability and Eligibility of the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) for Patients who Underwent Revascularization with Percutaneous Coronary Intervention. J Clin Med. 2020;9(9):2889. DOI:10.3390/jcm9092889.

3. Wu E, Desta L, Broström A, Mårtensson J. Effectiveness of Enhanced External Counterpulsation Treatment on Symptom Burden, Medication Profile, Physical Capacity, Cardiac Anxiety, and Health-Related Quality of Life in Patients With Refractory Angina Pectoris. J Cardiovasc Nurs. 2020;35(4):375-385. DOI:10.1097/JCN.0000000000000638

4. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407-477. DOI:10.1093/eurheartj/ehz425

5. Mareev VYu, Fomin IV, Ageev FT. Clinical recommendations of OSSN RKO RNMOT. Heart failure: chronic (CHF) and acute decompensated (ODSF). Diagnostics, prevention and treatment. Kardiologiia. 2018;58(S6):8-164 (In Russ.) DOI:10.18087/cardio.2475.

6. Mamieva ZA, Lishuta AS, Belenkov YuN, et al. Possibilities of Enhanced External Counterpulsation Using in Clinical Practice. Rational Pharmacotherapy in Cardiology. 2017;13(2):238-47 (In Russ.)

7. McKenna C, McDaid C, Suekarran S, et al. Enhanced external counterpulsation for the treatment of stable angina and heart failure: a systematic review and economic analysis. Health Technol Assess. 2009;13:1-90. DOI:10.3310/hta13240.

8. Michaels AD, Accad M, Ports TA, et al. Left ventricular systolic unloading and augmentation of intracoronary pressure and Doppler flow during enhanced external counterpulsation. Circulation. 2002;106:1237-42. DOI:10.1161/01.cir.0000028336.95629.b0.

9. Cai D, Wu R, Shao Y. Experimental study of the effect of external counterpulsation on blood circulation in the lower extremities. Clin Invest Med. 2000;23:239-47.

10. Luo C, Liu D, Wu G. Effect of enhanced external counterpulsation on coronary slow flow and its relation with endothelial function and inflammation: a mid-term follow-up study. Cardiology. 2012;122(4):260-8. DOI:10.1159/000339876.

11. Karaganov KS, Lishuta AS, Belenkov YN. The Use of Enhanced External Counterpulsation in the Treatment of Patients with Coronary Artery Disease. Rational Pharmacotherapy in Cardiology. 2020;16(4):579-84 (In Russ.) DOI:10.20996/1819-6446-2020-08-07.

12. Belenkov YuN, Privalova EV, Danilogorskaya YuA, Shchendrygina AA. Structural and functional changes in the microvasculature at the capillary level in patients with cardiovascular diseases (arterial hypertension, coronary heart disease, chronic heart failure), which can be observed during computer video capillaroscopy. Cardiology and Cardiovascular Surgery. 2012;2:49-55 (In Russ.)

13. Lins L, Carvalho FM. SF-36 total score as a single measure of health-related quality of life: Scoping review. SAGE Open Med. 2016;4:2050312116671725. DOI:10.1177/2050312116671725.

14. Arora RR, Chou TM, Jain D, et al. Effects of enhanced external counterpulsation on Health-Related Quality of Life continue 12 months after treatment: a substudy of the Multicenter Study of Enhanced External Counterpulsation. J Investig Med. 2002;50(1):25-32. DOI:10.2310/6650.2002.33514.

15. Shah SA, Shapiro RJ, Mehta R, Snyder JA. Impact of enhanced external counterpulsation on Canadian Cardiovascular Society angina class in patients with chronic stable angina: a meta-analysis Pharmacotherapy. 2010;30(7):639-45. DOI:10.1592/phco.30.7.639.

16. Zhang C, Liu X, Wang X, et al. 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(47):e2002. DOI:10.1097/MD.0000000000002002.

17. Jan R, Khan A, Zahid S, et al. 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. DOI:10.7759/cureus.7987.

18. Lin S, Xiao-Ming W, Gui-Fu W. Expert consensus on the clinical application of enhanced external counterpulsation in elderly people (2019). Aging Med (Milton). 2020;3(1):16-24. DOI:10.1002/agm2.12097.

19. Xu L, Chen X, Cui M, Ren C, et al. The improvement of the shear stress and oscillatory shear index of coronary arteries during Enhanced External Counterpulsation in patients with coronary heart disease. PLoS One. 2020;15(3):e0230144. DOI:10.1371/journal.pone.0230144.

20. Kulchitskaya DB, Shovkun TV, Yarnykh EV, et al. Effect of external counterpulsation on the state of microcirculation in patients with ischemic heart disease complicated by the development of chronic heart failure after surgical and endovascular myocardial revascularization. Questions of Balneology, Physiotherapy and Therapeutic Physical Culture. 2019;96(5):5-10 (In Russ.) DOI:10.17116/kurort2019960515.

21. Hoong CWS, Tan MLS, Kao SL, Khoo EYH. Effects of external counter-pulsation on endothelial function assessed by peripheral artery tonometry, levels of glycaemia and metabolic markers in individuals with type 2 diabetes mellitus. Diabetes Metab Syndr. 2020;14(6):2139-2145. DOI:10.1016/j.dsx.2020.11.003.

22. Hashemi M, Hoseinbalam M, Khazaei M. Long-term effect of enhanced external counterpulsation on endothelial function in the patients with intractable angina. Heart Lung Circ. 2008;17(5):3837. DOI:10.1016/j.hlc.2008.02.001.

23. Wu E, Mårtensson J, Desta L, Broström A. Adverse events and their management during enhanced external counterpulsation treatment in patients with refractory angina pectoris: observations from a routine clinical practice. Eur J Cardiovasc Nurs. 2021 May 18;zvab040. DOI:10.1093/eurjcn/zvab040.

24. Wu E, Mårtensson J, Desta L, Broström A. Predictors of treatment benefits after enhanced external counterpulsation in patients with refractory angina pectoris. Clin Cardiol. 2021;44(2):160-167. DOI:10.1002/clc.23516.


For citation:


Karaganov K.S., Slepova O.A., Lishuta A.S., Solomakhina N.I., Belenkov Yu.N. Medium-term Effects of Enhanced External Counterpulsation in the Structural and Functional Parameters of Blood Vessels in Patients with Coronary Artery Disease. Rational Pharmacotherapy in Cardiology. 2021;17(4):557-563. https://doi.org/10.20996/1819-6446-2021-08-03

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ISSN 1819-6446 (Print)
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