External Counterpulsation

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Randy W. Braith - One of the best experts on this subject based on the ideXlab platform.

  • enhanced External Counterpulsation eecp decreases advanced glycation end products and proinflammatory cytokines in patients with non insulin dependent type ii diabetes mellitus for up to 6 months following treatment
    Acta Diabetologica, 2016
    Co-Authors: Paloma D. Sardina, Jeffrey S. Martin, Wojciech K Dzieza, Randy W. Braith
    Abstract:

    Aims Enhanced External Counterpulsation (EECP) is a noninvasive, non-pharmacologic intervention proven to increase nitric oxide bioavailability in patients with coronary artery disease. The purpose of the present study was to evaluate the potential clinical benefits of EECP on advanced glycation end products (AGEs) and proinflammatory cytokine concentrations in patients with a clinical diagnosis of type II diabetes mellitus (T2DM).

  • enhanced External Counterpulsation reduces indices of central blood pressure and myocardial oxygen demand in patients with left ventricular dysfunction
    Clinical and Experimental Pharmacology and Physiology, 2015
    Co-Authors: Darren T Beck, Paloma D. Sardina, Jeffrey S. Martin, Darren P. Casey, Randy W. Braith
    Abstract:

    Enhanced External Counterpulsation (EECP) therapy decreases angina episodes and improves quality of life in patients with left ventricular (LV) dysfunction. However, the underlying mechanisms relative to the benefits of EECP therapy in patients with LV dysfunction have not been fully elucidated. The purpose of this study was to investigate the effects of EECP on indices of central haemodynamics, aortic pressure wave reflection characteristics, and estimates of LV load and myocardial oxygen demand in patients with LV dysfunction. Patients with chronic stable angina and LV ejection fraction 30%, were randomized to either an EECP group (LV ejection fraction = 35.1 ± 4.6%; n = 10) or sham-EECP group (LV ejection fraction = 34.3 ± 4.2%; n = 7). Pulse wave analysis of the central aortic pressure waveform and LV function were evaluated by applanation tonometry before and after 35 1-h sessions of EECP or sham-EECP. Enhanced External Counterpulsation therapy was effective in reducing indices of LV wasted energy and myocardial oxygen demand by 25% and 19%, respectively. In addition, indices of coronary perfusion pressure and subendocardial perfusion were increased by 9% and 30%, respectively, after EECP. Our data indicate that EECP may be useful as adjuvant therapy for improving functional classification in heart failure patients through reductions in central blood pressure, aortic pulse pressure, wasted LV energy, and myocardial oxygen demand, which also suggests improvements in ventricular-vascular interactions.

  • Antiglycemic Benefits of Enhanced External Counterpulsation in Patients With Type II Diabetes Mellitus
    The FASEB Journal, 2015
    Co-Authors: Paloma D. Sardina, Joseph C. Avery, Jeffrey S. Martin, Randy W. Braith
    Abstract:

    Purpose: Enhanced External Counterpulsation (EECP) improves arterial function, exercise tolerance, and angina symptoms in patients with coronary artery disease (CAD) and ischemic left ventricular d...

  • enhanced External Counterpulsation improves endothelial function and exercise capacity in patients with ischaemic left ventricular dysfunction
    Clinical and Experimental Pharmacology and Physiology, 2014
    Co-Authors: Darren T Beck, Paloma D. Sardina, Joseph C. Avery, Jeffrey S. Martin, Darren P. Casey, Randy W. Braith
    Abstract:

    Summary Enhanced External Counterpulsation (EECP) therapy decreases angina episodes and improves quality of life in patients with left ventricular (LV) dysfunction (LVD). However, studies have not elucidated the mechanisms of action and overall effects of EECP in patients with LVD. The purpose of the present study was to investigate the effects of EECP on endothelial function in peripheral conduit arteries and exercise capacity (peak Vo2) in patients with LVD. Patients with ischaemic LVD (ejection fraction (EF) 34.5 ± 4.2%; n = 9) and patients with symptomatic coronary artery disease (CAD) and preserved LV function (EF 53.5 ± 6.6%; n = 15) were studied before and after 35 sessions (1 h) of EECP. Brachial and femoral artery flow-mediated dilation (bFMD and fFMD, respectively) were evaluated using high-resolution ultrasound. Enhanced External Counterpulsation elicited similar significant improvements in the following FMD parameters in the CAD and LVD groups (P ≥ 0.05 between groups for all): absolute bFMD (+53% and +70%, respectively), relative bFMD (+50% and +74%, respectively), bFMD normalized for shear rate (+70% and +61%, respectively), absolute fFMD (+33% and +21%, respectively) and relative fFMD (+32% and +17%, respectively). In addition, EECP significantly improved plasma levels of nitrate/nitrite (+55% and +28%) and prostacyclin (+50% and +70%), as well as peak Vo2 (+36% and +21%), similarly in both the CAD and LVD groups (P ≥ 0.05 between groups for all). Despite reduced LV function, EECP therapy significantly improves peripheral vascular function and functional capacity in CAD patients with ischaemic LVD to a similar degree to that seen in CAD patients with preserved LV function.

  • peripheral resistance artery blood flow in subjects with abnormal glucose tolerance is improved following enhanced External Counterpulsation therapy
    Applied Physiology Nutrition and Metabolism, 2014
    Co-Authors: Jeffrey S. Martin, Darren T Beck, Randy W. Braith
    Abstract:

    Enhanced External Counterpulsation (EECP) improves resistance artery function in coronary artery disease patients. However, whether EECP elicits similar effects in persons with abnormal glucose tolerance (AGT) is unknown. Here we provide novel evidence that EECP significantly improves resistance arterial function in the forearm of persons with AGT, whereas the calf only approached significance (P ≤ 0.10). These improvements were coincident with greater glycemic control, providing further insight into the potential mechanisms of EECP-mediated alterations in glycemia.

Ozlem Soran - One of the best experts on this subject based on the ideXlab platform.

William Lawson - One of the best experts on this subject based on the ideXlab platform.

  • enhanced External Counterpulsation is cost effective in reducing hospital costs in refractory angina patients
    Clinical Cardiology, 2015
    Co-Authors: William Lawson, Elizabeth D Kennard, John C K Hui, Georgiann Linnemeier
    Abstract:

    Background Enhanced External Counterpulsation (EECP) is effective in the treatment of refractory angina, a condition suffered by 1.7 million Americans. Declining cardiovascular mortality and appropriate use criteria may further increase this number. Hypothesis EECP is hypothesized to be cost-effective in reducing hospitalizations in refractory angina patients. Methods The data used in this analysis were collected in phase II of the International EECP Patient Registry (IEPR-II). Data were collected on changes in Canadian Cardiovascular Society functional class, Duke Activity Status Index, and number of hospitalizations in the 6 months prior to EECP and in the 6- and 12-month intervals following EECP. Estimates of the changes in annual cost of all-cause hospitalization before and after EECP therapy were calculated by the product of the differences in hospitalization rates in the 6-month interval before and after EECP treatment and estimated hospitalization and physician charges after subtracting the average cost of EECP. Results Data for 1015 patients were analyzed. Hospitalization occurred in 55.2% of patients, an average of 1.7 ± 1.4 hospitalizations/patient, in the 6-month period before 35 hours of EECP; and in 24.4%, an average of 1.4 ± 1.0 hospitalizations/patient, during the 6- to 12-month period after EECP. The average hospitalization and physician charge in the US was $17 995, and the average EECP cost was $4880, yielding an annual cost savings/patient of $17 074. Conclusions Treatment of refractory angina patients with EECP resulted in improvement in angina and functional class accompanied by a sustained reduction in health care costs over 1 year of follow-up.

  • enhanced External Counterpulsation attenuates atherosclerosis progression through modulation of proinflammatory signal pathway
    Arteriosclerosis Thrombosis and Vascular Biology, 2010
    Co-Authors: Yan Zhang, Xiaolin Chen, Donghong Liu, Yafei Jin, Kuijian Wang, William Lawson, John C K Hui, Yugang Dong, Zhen-sheng Zheng
    Abstract:

    Objective— Shear stress may be the most crucial local factor affecting atherogenesis. The present study investigated the effect of exposure to increased shear stress promoted by enhanced External Counterpulsation (EECP) on the progression of atherosclerosis and the underlying inflammation-related molecular mechanisms in a porcine model of hypercholesterolemia. Methods and Results— Hypercholesterolemic pigs were subjected to a 7-week EECP intervention while being fed a high-cholesterol diet. EECP resulted in a 34.38% increase of mean wall shear stress and a significantly lower pulsatility index in the brachial artery. The animals receiving EECP showed a marked reduction in atherosclerotic lesion size in the coronary artery and abdominal aorta compared with the hypercholesterolemic control group, associated with a decrease in macrophage accumulation. The expression of a set of genes involved in inflammation (including C-reactive protein [CRP], complement 3a, vascular cell adhesion molecule-1 [VCAM-1], and inducible nitric oxide synthase), mitogen-activated protein kinase (MAPK)-p38 phosphorylation, and nuclear factor-κB (NF-κB) activation, was attenuated. Conclusion— These findings suggested that long-term EECP exerts a retarding effect on atherosclerosis by downregulating proinflammatory gene expression. The underlying mechanisms are related to chronic exposure to increased pulsatile shear stress promoted by EECP; this exposure suppresses the overactivation of the MAPK-P38/NF-κB/VCAM-1 signaling pathway induced by hypercholesterolemia.

  • enhanced External Counterpulsation is an effective treatment for syndrome x
    International Journal of Cardiology, 2009
    Co-Authors: Kenneth D. Kronhaus, William Lawson
    Abstract:

    Enhanced External Counterpulsation (EECP) was used to treat 30 patients with refractory angina due to cardiac Syndrome X, with an initial improvement in CCS angina class (3.57 to 1.43; p<0.001) and regional ischemia in all treated patients. At a mean of 11.9 months follow-up, 87% of patients had sustained improvement in angina and were without MACE. EECP, by improving endothelial function, may be an effective and durable treatment for this often difficult to treat problem.

  • enhanced External Counterpulsation in the treatment of chronic refractory angina a long term follow up outcome from the international enhanced External Counterpulsation patient registry
    Clinical Cardiology, 2008
    Co-Authors: Poay Huan Loh, Elizabeth D Kennard, William Lawson, Gregory W Barsness, John G F Cleland, Amal A Louis, Jocelyn F Cook, John L Caplin, Ozlem Soran
    Abstract:

    Background: The management of patients who suffer from medically refractory angina and are unsuitable for conventional revascularization therapy is often unsatisfactory. Enhanced External Counterpulsation (EECP) is a noninvasive treatment that is safe and effective immediately after a course of treatment. However, the duration of benefit is less certain. Hypothesis: To evaluate the 3-year outcome of EECP treatment. Methods: One thousand four hundred and twenty seven patients from 36 centers registered in the International EECP Patient Registry (IEPR)—Phase 1 was prospectively followed for a median of 37 months. Two hundred and twenty patients (15.4%) died, while 1,061 patients (74.4%) completed their follow-up. Results: The mean age was 66 ± 11 years and 72% were men. Seventy-six percent had multivessel coronary disease for 11 ± 8 years. Eighty-eight percent had a prior percutaneous or surgical revascularization and 82% were unsuitable for further coronary intervention. Immediately post-EECP, the proportion of patients with severe angina (Canadian Cardiovascular Angina Classification [CCS] III/IV) were reduced from 89% to 25%, p<0.001. The CCS class was improved by at least 1 class in 78% of the patients and by at least 2 classes in 38%. This was sustained in 74% of the patients during follow-up. Thirty-six percent of the patients had CCS II or less angina, which was better than pre-EECP state without a major adverse cardiovascular event during follow-up. More severe baseline angina and a history of heart failure or diabetes were independent predictors of unfavorable outcome. Conclusion: An EECP improves angina and quality of life immediately after a course of treatment. For most of the patients, these beneficial effects are sustained for 3 years.

  • enhanced External Counterpulsation inhibits intimal hyperplasia by modifying shear stress responsive gene expression in hypercholesterolemic pigs
    Circulation, 2007
    Co-Authors: Yan Zhang, Xiaolin Chen, Donghong Liu, Jinyun Luo, Yafei Jin, Yan Xiong, Dianqiu Fang, Kuijian Wang, William Lawson, John C K Hui
    Abstract:

    Background— Enhanced External Counterpulsation (EECP) is a circulation assist device that may improve endothelial dysfunction by increasing shear stress. Chronic exposure of vascular endothelial cells and vascular smooth muscle cells to relatively high physiological shear stress has antiproliferative and vasoprotective effects. The present study hypothesizes that EECP inhibits intimal hyperplasia and atherogenesis by modifying shear stress–responsive gene expression. Methods and Results— Thirty-five male pigs were randomly assigned to 3 groups: high-cholesterol diet (n=11), high-cholesterol diet plus EECP (n=17), and usual diet (control; n=7). The coronary arteries and aortas were collected for histopathological study and immunohistochemical and Western blot analysis. The peak diastolic arterial wall shear stress during EECP increased significantly compared with before EECP (49.62±10.71 versus 23.92±7.28 dyne/cm2; P<0.001). Intimal hyperplasia was observed in the coronary arteries of the high-cholesterol ...

Elizabeth D Kennard - One of the best experts on this subject based on the ideXlab platform.

  • enhanced External Counterpulsation is cost effective in reducing hospital costs in refractory angina patients
    Clinical Cardiology, 2015
    Co-Authors: William Lawson, Elizabeth D Kennard, John C K Hui, Georgiann Linnemeier
    Abstract:

    Background Enhanced External Counterpulsation (EECP) is effective in the treatment of refractory angina, a condition suffered by 1.7 million Americans. Declining cardiovascular mortality and appropriate use criteria may further increase this number. Hypothesis EECP is hypothesized to be cost-effective in reducing hospitalizations in refractory angina patients. Methods The data used in this analysis were collected in phase II of the International EECP Patient Registry (IEPR-II). Data were collected on changes in Canadian Cardiovascular Society functional class, Duke Activity Status Index, and number of hospitalizations in the 6 months prior to EECP and in the 6- and 12-month intervals following EECP. Estimates of the changes in annual cost of all-cause hospitalization before and after EECP therapy were calculated by the product of the differences in hospitalization rates in the 6-month interval before and after EECP treatment and estimated hospitalization and physician charges after subtracting the average cost of EECP. Results Data for 1015 patients were analyzed. Hospitalization occurred in 55.2% of patients, an average of 1.7 ± 1.4 hospitalizations/patient, in the 6-month period before 35 hours of EECP; and in 24.4%, an average of 1.4 ± 1.0 hospitalizations/patient, during the 6- to 12-month period after EECP. The average hospitalization and physician charge in the US was $17 995, and the average EECP cost was $4880, yielding an annual cost savings/patient of $17 074. Conclusions Treatment of refractory angina patients with EECP resulted in improvement in angina and functional class accompanied by a sustained reduction in health care costs over 1 year of follow-up.

  • Abstract 15742: Long Term Clinical Outcomes and Major Adverse Cardiac Event Rates of Enhanced External Counterpulsation Therapy in the Real World Settings in Patients with Coronary Artery Disease and Left Ventricular Dysfunction
    Circulation, 2011
    Co-Authors: Ozlem Soran, Elizabeth D Kennard, Sheryl F Kelsey
    Abstract:

    Objectives: Enhanced External Counterpulsation (EECP) is a noninvasive circulatory assist device that has recently emerged as a treatment option for refractory angina in left ventricular dysfunctio...

  • enhanced External Counterpulsation in the treatment of chronic refractory angina a long term follow up outcome from the international enhanced External Counterpulsation patient registry
    Clinical Cardiology, 2008
    Co-Authors: Poay Huan Loh, Elizabeth D Kennard, William Lawson, Gregory W Barsness, John G F Cleland, Amal A Louis, Jocelyn F Cook, John L Caplin, Ozlem Soran
    Abstract:

    Background: The management of patients who suffer from medically refractory angina and are unsuitable for conventional revascularization therapy is often unsatisfactory. Enhanced External Counterpulsation (EECP) is a noninvasive treatment that is safe and effective immediately after a course of treatment. However, the duration of benefit is less certain. Hypothesis: To evaluate the 3-year outcome of EECP treatment. Methods: One thousand four hundred and twenty seven patients from 36 centers registered in the International EECP Patient Registry (IEPR)—Phase 1 was prospectively followed for a median of 37 months. Two hundred and twenty patients (15.4%) died, while 1,061 patients (74.4%) completed their follow-up. Results: The mean age was 66 ± 11 years and 72% were men. Seventy-six percent had multivessel coronary disease for 11 ± 8 years. Eighty-eight percent had a prior percutaneous or surgical revascularization and 82% were unsuitable for further coronary intervention. Immediately post-EECP, the proportion of patients with severe angina (Canadian Cardiovascular Angina Classification [CCS] III/IV) were reduced from 89% to 25%, p<0.001. The CCS class was improved by at least 1 class in 78% of the patients and by at least 2 classes in 38%. This was sustained in 74% of the patients during follow-up. Thirty-six percent of the patients had CCS II or less angina, which was better than pre-EECP state without a major adverse cardiovascular event during follow-up. More severe baseline angina and a history of heart failure or diabetes were independent predictors of unfavorable outcome. Conclusion: An EECP improves angina and quality of life immediately after a course of treatment. For most of the patients, these beneficial effects are sustained for 3 years.

  • two year clinical outcomes after enhanced External Counterpulsation eecp therapy in patients with refractory angina pectoris and left ventricular dysfunction report from the international eecp patient registry
    American Journal of Cardiology, 2006
    Co-Authors: Ozlem Soran, Elizabeth D Kennard, Abdallah G Kfoury, Sheryl F Kelsey
    Abstract:

    Enhanced External Counterpulsation (EECP) is a noninvasive circulatory assist device that has recently emerged as a treatment option for refractory angina in left ventricular (LV) dysfunction. This 2-year cohort study describes the long-term follow-up of patients who had severe LV dysfunction that was treated with EECP for angina pectoris and reports clinical outcomes, event-free survival rates, and the incidence of repeat EECP. This study included 363 patients who had refractory angina and LV ejection fraction ≤35%. Most patients reported quality of life as poor. After completion of treatment, there was a significant decrease in severity of angina class (p

  • frequency and efficacy of repeat enhanced External Counterpulsation for stable angina pectoris from the international eecp patient registry
    American Journal of Cardiology, 2005
    Co-Authors: Andrew D. Michaels, Ozlem Soran, Sheryl F Kelsey, Elizabeth D Kennard, John C K Hui, Gregory W Barsness, William Lawson
    Abstract:

    We assessed the frequency, efficacy, predictors, and long-term success of repeat enhanced External Counterpulsation (EECP) therapy in relieving angina in a large cohort of patients who had chronic angina pectoris and had undergone a full course of EECP. Within 2 years of the initial course of EECP, the rate of repeat EECP was 18%, which occurred at a mean interval of 378 days after initial EECP. Of those who underwent repeat EECP, 70% had a decrease of ≥1 angina class at the end of repeat EECP with similar decreases in nitroglycerin use.

Darren T Beck - One of the best experts on this subject based on the ideXlab platform.

  • enhanced External Counterpulsation reduces indices of central blood pressure and myocardial oxygen demand in patients with left ventricular dysfunction
    Clinical and Experimental Pharmacology and Physiology, 2015
    Co-Authors: Darren T Beck, Paloma D. Sardina, Jeffrey S. Martin, Darren P. Casey, Randy W. Braith
    Abstract:

    Enhanced External Counterpulsation (EECP) therapy decreases angina episodes and improves quality of life in patients with left ventricular (LV) dysfunction. However, the underlying mechanisms relative to the benefits of EECP therapy in patients with LV dysfunction have not been fully elucidated. The purpose of this study was to investigate the effects of EECP on indices of central haemodynamics, aortic pressure wave reflection characteristics, and estimates of LV load and myocardial oxygen demand in patients with LV dysfunction. Patients with chronic stable angina and LV ejection fraction 30%, were randomized to either an EECP group (LV ejection fraction = 35.1 ± 4.6%; n = 10) or sham-EECP group (LV ejection fraction = 34.3 ± 4.2%; n = 7). Pulse wave analysis of the central aortic pressure waveform and LV function were evaluated by applanation tonometry before and after 35 1-h sessions of EECP or sham-EECP. Enhanced External Counterpulsation therapy was effective in reducing indices of LV wasted energy and myocardial oxygen demand by 25% and 19%, respectively. In addition, indices of coronary perfusion pressure and subendocardial perfusion were increased by 9% and 30%, respectively, after EECP. Our data indicate that EECP may be useful as adjuvant therapy for improving functional classification in heart failure patients through reductions in central blood pressure, aortic pulse pressure, wasted LV energy, and myocardial oxygen demand, which also suggests improvements in ventricular-vascular interactions.

  • enhanced External Counterpulsation improves endothelial function and exercise capacity in patients with ischaemic left ventricular dysfunction
    Clinical and Experimental Pharmacology and Physiology, 2014
    Co-Authors: Darren T Beck, Paloma D. Sardina, Joseph C. Avery, Jeffrey S. Martin, Darren P. Casey, Randy W. Braith
    Abstract:

    Summary Enhanced External Counterpulsation (EECP) therapy decreases angina episodes and improves quality of life in patients with left ventricular (LV) dysfunction (LVD). However, studies have not elucidated the mechanisms of action and overall effects of EECP in patients with LVD. The purpose of the present study was to investigate the effects of EECP on endothelial function in peripheral conduit arteries and exercise capacity (peak Vo2) in patients with LVD. Patients with ischaemic LVD (ejection fraction (EF) 34.5 ± 4.2%; n = 9) and patients with symptomatic coronary artery disease (CAD) and preserved LV function (EF 53.5 ± 6.6%; n = 15) were studied before and after 35 sessions (1 h) of EECP. Brachial and femoral artery flow-mediated dilation (bFMD and fFMD, respectively) were evaluated using high-resolution ultrasound. Enhanced External Counterpulsation elicited similar significant improvements in the following FMD parameters in the CAD and LVD groups (P ≥ 0.05 between groups for all): absolute bFMD (+53% and +70%, respectively), relative bFMD (+50% and +74%, respectively), bFMD normalized for shear rate (+70% and +61%, respectively), absolute fFMD (+33% and +21%, respectively) and relative fFMD (+32% and +17%, respectively). In addition, EECP significantly improved plasma levels of nitrate/nitrite (+55% and +28%) and prostacyclin (+50% and +70%), as well as peak Vo2 (+36% and +21%), similarly in both the CAD and LVD groups (P ≥ 0.05 between groups for all). Despite reduced LV function, EECP therapy significantly improves peripheral vascular function and functional capacity in CAD patients with ischaemic LVD to a similar degree to that seen in CAD patients with preserved LV function.

  • peripheral resistance artery blood flow in subjects with abnormal glucose tolerance is improved following enhanced External Counterpulsation therapy
    Applied Physiology Nutrition and Metabolism, 2014
    Co-Authors: Jeffrey S. Martin, Darren T Beck, Randy W. Braith
    Abstract:

    Enhanced External Counterpulsation (EECP) improves resistance artery function in coronary artery disease patients. However, whether EECP elicits similar effects in persons with abnormal glucose tolerance (AGT) is unknown. Here we provide novel evidence that EECP significantly improves resistance arterial function in the forearm of persons with AGT, whereas the calf only approached significance (P ≤ 0.10). These improvements were coincident with greater glycemic control, providing further insight into the potential mechanisms of EECP-mediated alterations in glycemia.

  • enhanced External Counterpulsation improves peripheral resistance artery blood flow in patients with coronary artery disease
    Applied Physiology Nutrition and Metabolism, 2014
    Co-Authors: Joseph C. Avery, Paloma D. Sardina, Darren T Beck, Darren P. Casey, Randy W. Braith
    Abstract:

    Enhanced External Counterpulsation (EECP) increases coronary artery perfusion and improves endothelium-dependent vasodilation in peripheral muscular conduit arteries. It is unknown whether vasodilatory capacity is improved in the peripheral resistance vasculature. Here we provide novel evidence from the first randomized, sham-controlled study that EECP increases peak limb blood flow and improves endothelium-dependent vasodilation in both calf and forearm resistance arteries in patients with coronary artery disease.

  • enhanced External Counterpulsation improves peripheral artery function and glucose tolerance in subjects with abnormal glucose tolerance
    Journal of Applied Physiology, 2012
    Co-Authors: Jeffrey S. Martin, Darren T Beck, Juan M Aranda, Randy W. Braith
    Abstract:

    Background: in coronary artery disease patients, enhanced External Counterpulsation (EECP) improves peripheral arterial function and nitric oxide (NO) bioavailability, which have been implicated in...

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