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Enhanced external counterpulsation improves endothelial function in patients with symptomatic coronary artery disease

Piero O. Bonetti, MD^*, Gregory W. Barsness, MD, FACC^*, Paul C. Keelan, MD^*, Theresa I. Schnell, RN^*, Geralyn M. Pumper, RN^*, Jeffrey T. Kuvin, MD, FACC, Robert P. Schnall, DSc, David R. Holmes, Jr, MD, FACC^*, Stuart T. Higano, MD, FACC^* and Amir Lerman, MD, FACC^*,*

^* Center for Coronary Physiology and Imaging and the Cardiac Catheterization Laboratory, Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota, USA
Department of Medicine/Division of Cardiology, New England Medical Center Hospitals, Tufts University School of Medicine, Boston, Massachusetts, USA
Itamar Medical Ltd., Caesarea, Israel

View larger version (14K): [in a new window]   Figure 1 Bland-Altman plot of reactive hyperemia-peripheral arterial tonometry (RH-PAT) repeatability data; RH-PAT index was determined on two consecutive days among 28 volunteers. The difference between the two paired readings is plotted against their average. The average difference and the upper and lower limits of agreement (2 SDs of the differences) are indicated.

View larger version (15K): [in a new window]   Figure 2 Effect of enhanced external counterpulsation on average Canadian Cardiovascular Society (CCS) class (A) and average Duke Activity Status Index (DASI) score (B). *p < 0.05 vs. day 1.

View larger version (12K): [in a new window]   Figure 3 Average peripheral arterial tonometry response to reactive hyperemia (RH-PAT index) on the four study days. *p < 0.05; p < 0.05 vs. pre-enhanced external counterpulsation (EECP) RH-PAT indexes on day 1, day 17, and day 35. Open bars = pre-EECP; solid bars = post-EECP.

View larger version (11K): [in a new window]   Figure 4 Average peripheral arterial tonometry response to the nonendothelium-dependent vasodilator nitroglycerin (NTG-PAT index) on the four study days, p = 0.594 (repeated measures analysis of variance). Open bars = pre-enhanced external counterpulsation (EECP); solid bars = post-EECP.

View larger version (17K): [in a new window]   Figure 5 Average peripheral arterial tonometry response to reactive hyperemia (RH-PAT index) before initiation and one month after completion of enhanced external counterpulsation (EECP) therapy in patients with or without improvement in functional status. (A) Canadian Cardiovascular Society (CCS) class; (B) Duke Activity Status Index (DASI) score. *p < 0.05 vs. day 1. Open bars = day 1; solid bars = 1-month follow-up.