Author + information
- Received October 11, 2002
- Revision received February 7, 2003
- Accepted February 10, 2003
- Published online May 21, 2003.
- 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*,* ()
- ↵*Reprint requests and correspondence:
Dr. Amir Lerman, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905, USA.
Objectives The goal of this study was to examine the effect of enhanced external counterpulsation (EECP) on endothelial function.
Background Enhanced external counterpulsation improves symptoms and exercise tolerance in patients with symptomatic coronary artery disease (CAD). However, the exact mechanisms by which this technique exerts its clinical benefit are unclear.
Methods Reactive hyperemia-peripheral arterial tonometry (RH-PAT), a noninvasive method to assess peripheral endothelial function by measuring reactive hyperemic response in the finger, was performed in 23 patients with refractory angina undergoing a 35-h course of EECP. In each patient RH-PAT measurements were performed before and after the first, at midcourse, and the last EECP session. In addition, RH-PAT response was assessed one month after completion of EECP therapy; RH-PAT index, a measure of reactive hyperemia, was calculated as the ratio of the digital pulse volume during reactive hyperemia divided by that at rest.
Results Enhanced external counterpulsation led to symptomatic improvement (≥1 Canadian Cardiovascular Society class) in 17 (74%) patients; EECP was associated with a significant immediate increase in average RH-PAT index after each treatment (p < 0.05). In addition, average RH-PAT index at one-month follow-up was significantly higher than that before EECP therapy (p < 0.05). When patients were divided by their clinical response, RH-PAT index at one-month follow-up increased only in those patients who experienced clinical benefit.
Conclusions Enhanced external counterpulsation enhances peripheral endothelial function with beneficial effects persisting at one-month follow-up in patients with a positive clinical response. This suggests that improvement in endothelial function may contribute to the clinical benefit of EECP in patients with symptomatic CAD.
☆ Supported by the National Institutes of Health (grant number R01 HL-63911), the Mayo Foundation, Rochester, Minnesota; the Margarete und Walther Lichtenstein Stiftung, Basel, Switzerland; the Freiwillige Akademische Gesellschaft, Basel, Switzerland; and unrestricted grants from Itamar Medical Ltd. and Vasomedical Inc.
Jonathan Abrams, MD, acted as the guest editor for this paper.
- Received October 11, 2002.
- Revision received February 7, 2003.
- Accepted February 10, 2003.
- American College of Cardiology Foundation