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Enhanced external counterpulsation for treatment of refractory angina pectoris

Novo, Giuseppina; Bagger, Jens Peder; Carta, Riccardo; Koutroulis, George; Hall, Roger; Nihoyannopoulos, Petros

Journal of Cardiovascular Medicine: May 2006 - Volume 7 - Issue 5 - p 335–339
doi: 10.2459/01.JCM.0000223255.24309.fa
Original articles
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Objective Enhanced external counterpulsation (EECP) is a noninvasive, well-tolerated treatment, effective for managing patients with refractory angina pectoris. The aim of this study was to evaluate the efficacy of EECP to relieve symptoms, to decrease myocardial ischaemia and to improve cardiac performance in patients with intractable angina, refractory to surgical and medical treatment.

Methods Twenty-five patients (24 men and one woman, mean age 65 years) with persistent ischaemia notwithstanding optimal medical therapy or after interventional or surgical procedure, received EECP sessions for 35 h. Each patient underwent dobutamine stress echocardiography before and after treatment. We evaluated modifications in either cardiac systolic or diastolic function, and in wall motion score index.

Results Eighty-four percent of patients showed an increase in at least one functional angina class. We did not observe any significant changes in fractional shortening and diastolic function. Thirty-six percent of patients had a reduction in the area of inducible ischaemia at dobutamine stress echocardiography after treatment. Unfortunately, because of the small sample size, we did not find any statistically significant difference. There was a trend showing that patients who benefited the most were those with the worst systolic function and with severely compromised segmental kinesis (P = NS).

Conclusions EECP is effective in relieving symptoms in patients with refractory angina and may reduce inducible ischaemia at dobutamine stress echocardiography, especially in patients with reduced systolic function and compromised segmental kinesis.

aDivision of Cardiology, Department of Internal Medicine, Cardiovascular and Nephro-Urological Diseases, University of Palermo, Palermo, Italy

bImperial College School of Medicine, NHLI and Cardiothoracic Directorate, Hammersmith Hospital, London, UK

cCardiology Clinic, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy

Received 29 April, 2005

Revised 16 September, 2005

Accepted 19 September, 2005

Correspondence and requests for reprints to Dr Giuseppina Novo, Via Villa Sperlinga 5, 90143 Palermo, Italy e-mail: pepenovo@hotmail.com

© 2006 Italian Federation of Cardiology. All rights reserved.