Enhanced external counterpulsation therapy

Significant clinical improvement without electrophysiologic remodeling

Charles A. Henrikson, Nisha Chandra

Research output: Contribution to journalArticle

Abstract

Background: Enhanced external counterpulsation therapy (EECP), in addition to improving coronary flow and increasing the time to ischemia, noninvasively alters hemodynamics in patients with severe coronary artery disease (CAD). Other treatments that alter hemodynamics, for example, balloon valvuloplasty, left ventricular assist devices, and pharmacologic antagonism of the rennin-angiotensin system, promote electrophysiologic remodeling, as evidenced by alterations in the QT interval. Methods: We studied 28 patients who completed a 7-week, 35-hour session of EECP to assess whether such therapy would also result in electrophysiologic remodeling. Results: All patients had class II-III angina, imaging-proven ischemia, and severe, near-inoperable CAD. Of 28 patients, with a mean age 62 ± 13 years (mean ± SD), 78% were male, 46% diabetic, 82% hypertensive, 60% had undergone angioplasty, and 67% had undergone bypass surgery. The mean ejection fraction was 44% (range 25-60%). Following EECP, most patients (82%) had at least a one full class improvement in their anginal pattern. In most patients, there was substantial baseline conduction system disease present: a mean QRS of 105 ± 19 ms. It is to be noted that there was no significant change in heart rate (HR), PR, QRS, or QTc intervals before and after EECP in either clinical responders or nonresponders. When analyzed by response to EECP, ejection fraction, or history of revascularization, there were still no detectable changes in ECG parameters (all P = NS). Conclusions: While EECP remains an effective treatment for severe CAD, it does not prompt early electrical remodeling of the heart.

Original languageEnglish (US)
Pages (from-to)265-269
Number of pages5
JournalAnnals of Noninvasive Electrocardiology
Volume9
Issue number3
DOIs
StatePublished - Jul 2004

Fingerprint

Counterpulsation
Coronary Artery Disease
Therapeutics
Ischemia
Hemodynamics
Chymosin
Atrial Remodeling
Balloon Valvuloplasty
Heart-Assist Devices
Angiotensins
Angioplasty
Electrocardiography
Heart Rate

Keywords

  • Coronary artery disease
  • Electrocardiogram
  • Electrophysiology
  • Enhanced external counterpulsation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Enhanced external counterpulsation therapy : Significant clinical improvement without electrophysiologic remodeling. / Henrikson, Charles A.; Chandra, Nisha.

In: Annals of Noninvasive Electrocardiology, Vol. 9, No. 3, 07.2004, p. 265-269.

Research output: Contribution to journalArticle

@article{05e92472ea1a4c739317b1ce76b1deb6,
title = "Enhanced external counterpulsation therapy: Significant clinical improvement without electrophysiologic remodeling",
abstract = "Background: Enhanced external counterpulsation therapy (EECP), in addition to improving coronary flow and increasing the time to ischemia, noninvasively alters hemodynamics in patients with severe coronary artery disease (CAD). Other treatments that alter hemodynamics, for example, balloon valvuloplasty, left ventricular assist devices, and pharmacologic antagonism of the rennin-angiotensin system, promote electrophysiologic remodeling, as evidenced by alterations in the QT interval. Methods: We studied 28 patients who completed a 7-week, 35-hour session of EECP to assess whether such therapy would also result in electrophysiologic remodeling. Results: All patients had class II-III angina, imaging-proven ischemia, and severe, near-inoperable CAD. Of 28 patients, with a mean age 62 ± 13 years (mean ± SD), 78{\%} were male, 46{\%} diabetic, 82{\%} hypertensive, 60{\%} had undergone angioplasty, and 67{\%} had undergone bypass surgery. The mean ejection fraction was 44{\%} (range 25-60{\%}). Following EECP, most patients (82{\%}) had at least a one full class improvement in their anginal pattern. In most patients, there was substantial baseline conduction system disease present: a mean QRS of 105 ± 19 ms. It is to be noted that there was no significant change in heart rate (HR), PR, QRS, or QTc intervals before and after EECP in either clinical responders or nonresponders. When analyzed by response to EECP, ejection fraction, or history of revascularization, there were still no detectable changes in ECG parameters (all P = NS). Conclusions: While EECP remains an effective treatment for severe CAD, it does not prompt early electrical remodeling of the heart.",
keywords = "Coronary artery disease, Electrocardiogram, Electrophysiology, Enhanced external counterpulsation",
author = "Henrikson, {Charles A.} and Nisha Chandra",
year = "2004",
month = "7",
doi = "10.1111/j.1542-474X.2004.93570.x",
language = "English (US)",
volume = "9",
pages = "265--269",
journal = "Annals of Noninvasive Electrocardiology",
issn = "1082-720X",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - Enhanced external counterpulsation therapy

T2 - Significant clinical improvement without electrophysiologic remodeling

AU - Henrikson, Charles A.

AU - Chandra, Nisha

PY - 2004/7

Y1 - 2004/7

N2 - Background: Enhanced external counterpulsation therapy (EECP), in addition to improving coronary flow and increasing the time to ischemia, noninvasively alters hemodynamics in patients with severe coronary artery disease (CAD). Other treatments that alter hemodynamics, for example, balloon valvuloplasty, left ventricular assist devices, and pharmacologic antagonism of the rennin-angiotensin system, promote electrophysiologic remodeling, as evidenced by alterations in the QT interval. Methods: We studied 28 patients who completed a 7-week, 35-hour session of EECP to assess whether such therapy would also result in electrophysiologic remodeling. Results: All patients had class II-III angina, imaging-proven ischemia, and severe, near-inoperable CAD. Of 28 patients, with a mean age 62 ± 13 years (mean ± SD), 78% were male, 46% diabetic, 82% hypertensive, 60% had undergone angioplasty, and 67% had undergone bypass surgery. The mean ejection fraction was 44% (range 25-60%). Following EECP, most patients (82%) had at least a one full class improvement in their anginal pattern. In most patients, there was substantial baseline conduction system disease present: a mean QRS of 105 ± 19 ms. It is to be noted that there was no significant change in heart rate (HR), PR, QRS, or QTc intervals before and after EECP in either clinical responders or nonresponders. When analyzed by response to EECP, ejection fraction, or history of revascularization, there were still no detectable changes in ECG parameters (all P = NS). Conclusions: While EECP remains an effective treatment for severe CAD, it does not prompt early electrical remodeling of the heart.

AB - Background: Enhanced external counterpulsation therapy (EECP), in addition to improving coronary flow and increasing the time to ischemia, noninvasively alters hemodynamics in patients with severe coronary artery disease (CAD). Other treatments that alter hemodynamics, for example, balloon valvuloplasty, left ventricular assist devices, and pharmacologic antagonism of the rennin-angiotensin system, promote electrophysiologic remodeling, as evidenced by alterations in the QT interval. Methods: We studied 28 patients who completed a 7-week, 35-hour session of EECP to assess whether such therapy would also result in electrophysiologic remodeling. Results: All patients had class II-III angina, imaging-proven ischemia, and severe, near-inoperable CAD. Of 28 patients, with a mean age 62 ± 13 years (mean ± SD), 78% were male, 46% diabetic, 82% hypertensive, 60% had undergone angioplasty, and 67% had undergone bypass surgery. The mean ejection fraction was 44% (range 25-60%). Following EECP, most patients (82%) had at least a one full class improvement in their anginal pattern. In most patients, there was substantial baseline conduction system disease present: a mean QRS of 105 ± 19 ms. It is to be noted that there was no significant change in heart rate (HR), PR, QRS, or QTc intervals before and after EECP in either clinical responders or nonresponders. When analyzed by response to EECP, ejection fraction, or history of revascularization, there were still no detectable changes in ECG parameters (all P = NS). Conclusions: While EECP remains an effective treatment for severe CAD, it does not prompt early electrical remodeling of the heart.

KW - Coronary artery disease

KW - Electrocardiogram

KW - Electrophysiology

KW - Enhanced external counterpulsation

UR - http://www.scopus.com/inward/record.url?scp=3843123261&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=3843123261&partnerID=8YFLogxK

U2 - 10.1111/j.1542-474X.2004.93570.x

DO - 10.1111/j.1542-474X.2004.93570.x

M3 - Article

VL - 9

SP - 265

EP - 269

JO - Annals of Noninvasive Electrocardiology

JF - Annals of Noninvasive Electrocardiology

SN - 1082-720X

IS - 3

ER -