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SCIENTIFIC STATEMENT:
Prevention of Torsade de Pointes in Hospital Settings
ACC 2009 Advocacy Position Statement: Principles for Comparative Effectiveness Research
2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery
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J Am Coll Cardiol, 2001; 37:93-99
© 2001 by the American College of Cardiology Foundation
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CLINICAL STUDY: CORONARY ARTERY DISEASE

Enhanced external counterpulsation improves exercise tolerance, reduces exercise-induced myocardial ischemia and improves left ventricular diastolic filling in patients with coronary artery disease

Hisashi Urano, MDa, Hisao Ikeda, MD, PhDa, Takafumi Ueno, MD, PhDa, Takahiro Matsumoto, MD, PhDa, Toyoaki Murohara, MD, PhDa and Tsutomu Imaizumi, MD, PhD, FACCa

a Department of Internal Medicine III, Kurume University School of Medicine, Kurume, Japan

Manuscript received May 1, 2000; revised manuscript received August 10, 2000, accepted September 26, 2000.

Reprint requests and correspondence: Dr. Hisao Ikeda, Department of Internal Medicine III, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan
ikeikeda{at}med.kurume-u.ac.jp

OBJECTIVES

We examined whether enhanced external counterpulsation (EECP) improves myocardial ischemia, exercise tolerance and cardiac function in patients with coronary artery disease (CAD).

BACKGROUND

Enhanced external counterpulsation reduces angina and improves exercise tolerance in patients with CAD. Some objective improvements of ischemia by EECP have been reported, but they should be confirmed further. Detailed hemodynamic effects of EECP have been less well documented.

METHODS

Enhanced external counterpulsation was performed for a total of 35 h in patients with stable CAD (n = 12) who showed evidence of exercise-induced myocardial ischemia despite conventional medical or surgical therapies. All patients had significant stenotic lesions in major coronary arteries.

RESULTS

Enhanced external counterpulsation improved all exercise test parameters (p < 0.05): exercise duration, time to 1-mm ST segment depression, rate-pressure product at peak exercise and rate-pressure product at 1-mm ST segment depression. Moreover, the prevalence of exercise-induced reversible perfusion defects by thallium scintigraphy decreased after treatment (p < 0.01). Enhanced external counterpulsation did not alter systolic function but improved diastolic filling, left ventricular (LV) end-diastolic pressure (p < 0.05) by cardiac catheterization and LV peak filling rate end-diastolic volume/s (p < 0.01) and time to peak filling rate (p < 0.05) by radionuclide scintigraphy. These hemodynamic improvements were associated with decreased plasma brain natriuretic peptides levels after EECP (p < 0.05).

CONCLUSIONS

Thus, EECP treatment improves exercise tolerance and reduced myocardial ischemia by thallium scintigraphy in association with improved LV diastolic filling in patients with stable CAD.

Abbreviations and Acronyms
  ANP = atrial natriuretic peptide
  BNP = brain natriuretic peptide
  CAD = coronary artery disease
  EECP = enhanced external counterpulsation
  LV = left ventricular
  LVEDP = left ventricular end-diastolic pressures
  MUST-EECP = Multicenter Study of Enhanced External Counterpulsation
  PER = peak ejection rate
  PFR = peak filling rate
  RPP = rate-pressure product




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