The Safety and Efficacy of Enhanced External Counterpulsation as a Treatment for Angina in Patients With Aortic Stenosis

Abstract

Background: Comorbid aortic stenosis (AS) has been considered a precaution when applying enhanced external counterpulsation (EECP) to individuals with angina due to concerns about treatment-related hemodynamic changes. Hypothesis: The aim of this study was to determine whether EECP safely reduces symptoms of myocardial ischemia and improves hemodynamics in individuals with AS. Methods: Forty-three patients with AS (average age, 73 years; 86% male) and 43 comparison patients without AS were chosen from a database of 1327 EECP patients. Canadian Cardiovascular Society (CCS) Functional Angina Classification, diastolic augmentation ratio, and blood pressure were measured at baseline and on completion of the course of EECP. Results: Thirty-five of the 43 patients with AS (81%, 95% CI: 66.6% to 91.6%) and 38 of the 43 without AS (88%, 95% CI: 74.9% to 96.1%) improved in angina class (P < 0.0001). There was no statistical difference between the percentages in patients with and without AS (P = 0.54). CCS angina class outcome was not associated with AS severity (P = 0.55). The percentage of patients with diastolic augmentation ratio ≥1.0 was 16.3% in both groups at baseline and improved to 39.5% in AS patients and 37.2% in non-AS patients after EECP (both P = 0.002). The average decreases in systolic blood pressure in subjects with AS (−15 mm Hg, 95% CI: 11 to 20, P < 0.0001) and without AS (−18 mm Hg, 95% CI: 14 to 22, P < 0.0001) were similar (P = 0.31). No major adverse cardiac events were reported. Conclusions: Angina patients with AS who undergo EECP had clinically important symptomatic and hemodynamic improvements comparable to their non-AS counterparts.

Safety and effectiveness of enhanced external counterpulsation (EECP) in refractory angina patients: A systematic reviews and meta-analysis

“…The mean age of patients was 27.1 years in the Gurovich study 15 and 76.8 years in the Braverman study. 16 All studies were published between 1999 and 2020. The evaluation of these studies quality, showed that, sixteen studies out of 17 studies submitted were of high quality and only one article was of low quality.…”

“…Seven studies 16,[18][19][20]23,24,28 including 291 patients assessed the Barchial Systolic Blood Pressure outcomes of the patients. The overall Inverse Variance Pooled MD calculated for Barchial SBP was 8.83 (95% CI; 7.34, 10.33) in favor of the post-EECP (P < 0.00001, Figure 3A).…”

Effect of Enhanced External Counterpulsation and Cardiac Rehabilitation on Quality of Life, Plasma Nitric Oxide, Endothelin 1 and High Sensitive CRP in Patients With Coronary Artery Disease: A Pilot Study

“…Lin et al [ 16 ] reported that EECP was able to improve the mean blood pressure and cerebral perfusion in patients after ischemic stroke. Another study concluded that angina patients with aortic stenosis who underwent EECP had clinically important symptomatic and hemodynamic improvements comparable to their non-aortic stenosis counterparts [ 17 ]. Ruangkanchanasetr et al [ 4 ] even demonstrated that EECP could improve the long-term renal function in cardiac patients especially in cases with declined renal function.…”

Angina and Its Management

“…Enhanced external counterpulsation is FDA approved for angina in the United States. [39][40][41][42][43][44][45][46][47] Transmyocardial Revascularization…”