The benefits and safety of external counterpulsation in symptomatic heart failure.

Abstract

BACKGROUND:

External counterpulsation is a safe and effective method of alleviating angina pectoris, but the mechanism of benefit is not understood.

OBJECTIVES:

To evaluate the safety and efficacy of external counterpulsation therapy in heart failure patients.

METHODS:

Fifteen symptomatic heart failure patients (subsequent to optimal medical and device therapy) underwent 35 hourly sessions of ECPT over a 7 week period. Before and after each ECPT session we performed pro-B-type natriuretic peptide and brachial artery function studies, administered a quality of life questionnaire, and assessed exercise tolerance and functional class.

RESULTS:

Baseline left ventricular ejection fraction was 28.1+/-5.8%. ECPT was safe and well tolerated and resulted in a reduction in pro-BNP levels (from 2,245+/- 2,149 pcg/ml to 1,558+/-1206 pcg/ml, P= 0.022). Exercise duration (Naughton protocol) improved (from 720+/-389 to 893+/-436 seconds, P= 0.0001), along with functional class (2.63+/-0.6 vs. 1.93+/-0.7, P= 0.023) and quality of life scores (54+/-22 vs. 67+/-23, P= 0.001). Nitroglycerine-mediated brachial vasodilatation increased (11.5+/-7.3% vs. 15.6+/-5.2%, P=0.049), as did brachial flow-mediated dilation (8.35+/-6.0% vs. 11.37+/-4.9%, P= 0.09).

CONCLUSIONS:

ECPT is safe for symptomatic heart failure patients and is associated with functional and neurohormonal improvement. Larger long-term randomized studies with a control arm are needed to confirm these initial encouraging observations.

• Authors: Edo Kaluski, Ziad Gabara, Nir Uriel, Olga Milo, Marina Leitman, Jerald Weisfogel, Vladimir Danicek, Zvi Vered, Gad Cotter
• Journal: The Israel Medical Association journal : IMAJ (Isr Med Assoc J) Vol. 8 Issue 10 Pg. 687-90 (Oct 2006) ISSN: 1565-1088 [Print] Israel
• PMID: 17125114 (Publication Type: Clinical Trial, Journal Article)

Topics

• Adult
• Aged
• Brachial Artery (physiology)
• Counterpulsation (adverse effects, methods)
• Exercise Test
• Heart Failure (therapy)
• Humans
• Male
• Middle Aged
• Quality of Life
• Surveys and Questionnaires
• Time Factors
• Treatment Outcome
• Ventricular Dysfunction, Left (therapy)
• Ventricular Function, Left