Application of enhanced external counterpulsation in treating patients with stable ischemic heart disease

Abstract Introduction Currently, enhanced external counterpulsation (EECP) is one of the safest non-invasive treatments for patients with coronary artery disease (CAD). In combination with traditional drug therapy, EECP can significantly improve the quality of life of patients by increasing coronary perfusion, improving myocardial contractile function, and improving endothelial function. Aim To study the effect of EECP on clinical status, quality of life (QL) and structural-functional state of blood vessels in patients with stable coronary artery disease. Materials and methods In the present study 67 CAD patients were included (average age 65.7±5.66 years; men 71.9%, angina pectoris of functional class II-III (FC)). All patients were on optimal medical therapy (ACE inhibitors, beta-blockers, antiplatelet agents, statins, nitrates), which remained unchanged during the follow-up. Patients were given a course of EECP (35 procedures 220–280 mmHg.art.). Test 6-minute walk (T6MW), QL (Minnesota Satisfaction Questionnaire (MSQ)), echocardiography (ejection fraction of the left ventricle (LVEF)) were performed at baseline and after 6 months. In addition, all the patients underwent laser photoplethysmography (Stiffness index (SI, m/s), phase shift (PS m/s) occlusion index (OI), nail fold videocapillaroscopy (capillary density at rest, after reactive hyperemia and venous occlusion (CDr, CDrh, CDvo, respectively, cap/mm2) and applanation tonometry (central aortic systolic pressure (CASP), (radial augmentation index (RAI)) in order to assess structural and functional characteristics of blood vessels. Results In six months after EECP, significant improvement in patient's condition was found. T6MW distance (212±32 vs 251±29 m, p<0.05), QL MSQ (20.1±6.2 vs 41,6±7,1, p<0.05) and LVEF (40.9±7,6% vs 45.2±10.1%, p<0.05) increased significantly. Stiffness of large vessels was found to be decreased. CASP, RAI and SI decreased significantly, (CASP: 131±15.8 vs 129±14.8 mmHg, p<0.05), (RAI: 97.2±25.1 vs 97±21.6%, p<0.05), (SI: 8.9±1.5 vs 8.8±,1.6 m/s, p<0.05), Functional characteristics of large blood vessels significantly improved (PS (5.6±1.2 vs 6.8±1.4 m/s, p<0.05). Microcirculation - Reflection index (106.7 vs 95.3%, p<0.05) and OI (1.5±0.3 vs 1.66±0.26, p<0.05) for all. Increase CDrest (44±12.2–44.6±11.5 capillaries, p>0.05), in samples with CDrh (45±14 vs 57±16 capillaries, p<0.05) and CDvo (55±15–56 vs 4±14.2 capillaries, p<0.05). Conclusion ECCP treatment of patients with stable CAD, in addition to optimal drug therapy, led to an increase in load tolerance and improvement of the QL, myocardial contractile function, accompanied by improvement of the structural and functional state of large vessels and microcirculatory bed. Funding Acknowledgement Type of funding sources: None.