Is there any positive remodeling after enhanced external counter pulsation in patients with severe refractory angina?
Majid Kiavar1, Naser Aslanabadi2, Azin Alizadehasl3, Ahmad Ahmadzadeh Pournaky4, Arash Hashemi5, Rezvanieh Salehi2, Mitra Chitsazan1, Sormeh Nourbakhsh6, Morteza Abdar Esfahani7
1 Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
2 Madani Cardiovascular, Medical and Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
3 Rajaie Cardiovascular, Medical and Research Center, Echocardiography Lab, Iran University of Medical Sciences, Tehran, IR Iran
4 Cardiology Department, Urmia University of Medical Sciences, Urmia, IR Iran
5 Cardiology Department, Erfan General Hospital, Tehran, IR Iran
6 Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
7 Cardiology Department, Isfahan University of Medical Sciences, Isfahan, IR Iran
Madani Cardiovascular, Medical and Research Center, Tabriz University of Medical Sciences, Tabriz
Source of Support: None, Conflict of Interest: None
Background: Patients with severe refractory cardiac angina who are not candidates for any form of invasive treatment and are already on optimal medical therapy have few therapeutic options. Enhanced external counter pulsation (EECP) offers an alternative palliative and possibly therapeutic option for these patients. EECP achieves this by inducing hemodynamic effects much similar to those of the intraaortic balloon pump.
Objectives: We sought to further evaluate these therapeutic effects, especially on the basis of echocardiographic data.
Patients and Methods: Thirty-two patients who had severe refractory angina despite full anti-ischemic medication and were poor candidates for invasive procedures were evaluated. After undergoing 35 sessions of EECP, the patients were followed up for 6 months for adverse events, change in quality of life, severity of the remaining symptoms according to the Canadian Cardiovascular Society (CCS) classification, and echocardiographic changes.
Results: After receiving standard EECP treatment regimen, the patients showed a marked increase in quality of life scores; a significant decrease in left ventricular (LV) end-diastolic volume index after 6 months (P = 0.045), in tandem with an increase in the LV myocardial performance index (P = 0.04) with no significant change in the LV ejection fraction; and a significant decrease in the CCS scores (P = 0.01). In addition, physical performance measures, including time to unset of angina during the exercise test, were significantly increased.
Conclusions: EECP is a useful and low-risk additive therapeutic option in patients with end-stage and non-responsive angina symptoms who are receiving optimal medical conventional treatments and are not good candidates for invasive procedures. This treatment can induce some positive remodeling in the LV.