Effects of enhanced external counterpulsation on arterial stiffness and myocardial oxygen demand in patients with chronic angina pectoris.
Effects of enhanced external counterpulsation on arterial stiffness and myocardial oxygen demand in patients with chronic angina pectoris.
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DOI：
10.1016/j.amjcard.2011.01.021
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发表时间：
2011-05-15
期刊：
影响因子：
--
通讯作者：
Braith RW
中科院分区：
文献类型：
--
作者：
Casey DP;Beck DT;Nichols WW;Conti CR;Choi CY;Khuddus MA;Braith RW
增强型体外反搏（EECP）是一种非侵入性方式，用于治疗不适合血运重建术的症状性冠状动脉疾病（CAD）患者。然而，EECP获益的潜在机制仍不清楚。我们假设动脉硬化和主动脉波反射的减少是EECP的治疗目标。冠心病伴慢性心绞痛患者随机（2：1比例）接受35次1小时EECP（n=28）或假EECP（n=14）。中心和外周动脉脉搏波速度（PWV）和主动脉波反射（增强指数; AIx）使用压平眼压测量之前，17和35 1小时治疗后。由合成的主动脉压力波推导出左室心肌耗氧量指标--左室压力能量损耗和主动脉收缩张力时间指数。运动持续时间，心绞痛阈值和峰值耗氧量采用分级跑台试验测量。治疗组在17次和35次治疗后中心动脉僵硬度和AIx降低。治疗组在35次治疗后外周动脉僵硬度指标降低。主动脉压力波反射的变化导致心肌需氧量降低和左心室能量浪费。在假手术组中未观察到中央或外周动脉硬度的变化。此外，EECP组的运动能力指标有所改善，但Sham组无变化。总之，EECP治疗可降低中心和外周动脉僵硬度，这可能解释慢性心绞痛患者治疗后心肌需氧量的改善。
Enhanced external counterpulsation (EECP) is a non-invasive modality for treatment of symptomatic coronary disease (CAD) in patients not amenable to revascularization procedures. However, the mechanism(s) underlying the benefits of EECP remain unknown. We hypothesized that reductions in arterial stiffness and aortic wave reflection are a therapeutic target for EECP. CAD patients with chronic angina pectoris were randomized (2:1 ratio) to either 35 1-hr sessions of EECP (n=28) or Sham-EECP (n=14). Central and peripheral arterial pulse wave velocity (PWV) and aortic wave reflection (augmentation index; AIx) were measured using applanation tonometry before, and after 17 and 35 1-hr treatment sessions. Wasted left ventricular pressure energy and aortic systolic tension time index, markers of left-ventricular myocardial oxygen demand were derived from the synthesized aortic pressure wave. Exercise duration, anginal threshold, and peak oxygen consumption were measured using a graded treadmill test. Central arterial stiffness and AIx were reduced following 17- and 35-sessions in the treatment group. Measures of peripheral arterial stiffness were reduced following 35 sessions in the treatment group. Changes in aortic pressure wave reflection resulted in decreased measures of myocardial oxygen demand and wasted left ventricular energy. No changes in either central or peripheral arterial stiffness were observed in the Sham group. Furthermore, measures of exercise capacity were improved in the EECP group, but unchanged in the Sham group. In conclusion, EECP therapy reduces central and peripheral arterial stiffness, which may explain improvements in myocardial oxygen demand in patients with chronic angina pectoris following treatment.
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