Enhanced external counterpulsation improves endothelial function in patients with symptomatic coronary artery disease
Enhanced external counterpulsation improves endothelial function in patients with symptomatic coronary artery disease
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DOI：
10.1016/s0735-1097(03)00329-2
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发表时间：
2003-05-21
影响因子：
24
通讯作者：
Lerman, A
中科院分区：
文献类型：
--
作者：
Bonetti, PO;Barsness, GW;Lerman, A
目的：本研究的目的是研究增强外反搏（EECP）对内皮功能的影响。背景：增强体外反搏可改善症状性冠状动脉疾病（CAD）患者的症状和运动耐受性。然而，这项技术发挥其临床效益的确切机制尚不清楚。方法对23例接受35小时EECP治疗的难治性心绞痛患者进行反应性充血-外周动脉血压计（RH-PAT），这是一种通过测量手指反应性充血反应来评估外周内皮功能的无创方法。每位患者的RH-PAT测量分别在第一次EECP治疗前后、中期和最后一次EECP治疗期间进行。此外，在EECP治疗完成一个月后评估RH-PAT反应；RH-PAT指数是衡量反应性充血的指标，计算结果为反应性充血期间的数字脉搏体积除以静止时的脉搏体积之比。结果：17例（74%）患者体外反搏增强导致症状改善（大于或等于加拿大心血管学会1级）；EECP与每次治疗后平均RH-PAT指数的显著升高相关（p < 0.05）。随访1个月时平均RH-PAT指数显著高于EECP治疗前（p < 0.05）。当根据临床反应对患者进行分组时，只有那些临床获益的患者在一个月的随访中RH-PAT指数升高。结论加强。体外反搏增强外周内皮功能，在临床反应积极的患者一个月的随访中，其有益效果持续存在。这表明内皮功能的改善可能有助于EECP对症状性CAD患者的临床益处。(C) 2003年由美国心脏病学会基金会发布。
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 (greater than or equal to1 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. (C) 2003 by the American College of Cardiology Foundation.