Subject(s)
Angioplasty, Balloon, Coronary , Heart Arrest/mortality , Heart Arrest/therapy , Outpatients , Survivors , Adult , Aged , Aged, 80 and over , Anti-Arrhythmia Agents/therapeutic use , Cardiotonic Agents/therapeutic use , Defibrillators, Implantable , Female , Follow-Up Studies , Humans , Intra-Aortic Balloon Pumping , Intraoperative Complications/etiology , Intraoperative Complications/mortality , Male , Middle Aged , Minnesota , Myocardial Ischemia/mortality , Myocardial Ischemia/therapy , Postoperative Complications/etiology , Postoperative Complications/mortality , Retrospective Studies , Shock, Cardiogenic/mortality , Shock, Cardiogenic/therapy , Survival Analysis , Time Factors , Treatment Outcome , Ventricular Fibrillation/mortality , Ventricular Fibrillation/therapyABSTRACT
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 (>/=1 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.
Subject(s)
Coronary Disease/physiopathology , Counterpulsation , Endothelium, Vascular/physiopathology , Aged , Blood Volume , Coronary Disease/therapy , Female , Fingers/blood supply , Humans , Hyperemia , Male , Plethysmography , Prospective StudiesABSTRACT
Outcome studies of percutaneous coronary intervention (PCI) with conventional balloon angioplasty have established increased in-hospital and 1-year mortality in patients with left ventricular (LV) dysfunction compared with others. It is unclear whether recent PCI practice innovations, including stents and adjunctive pharmacotherapy, have made PCI safer and more effective in patients with LV dysfunction. We evaluated the influence of LV ejection fraction (EF) indexes on in-hospital and 1-year outcomes in 1,458 patients within the National Heart, Lung, and Blood Institute-sponsored Dynamic Registry. Patients (n = 300) with acute myocardial infarction were excluded. The remaining 1,158 patients were subdivided into 3 categories: group 1, EF
Subject(s)
Angioplasty, Balloon, Coronary/mortality , Registries , Ventricular Dysfunction, Left/mortality , Aged , Confidence Intervals , Coronary Angiography , Coronary Disease/mortality , Coronary Disease/therapy , Endpoint Determination , Female , Follow-Up Studies , Hospital Mortality , Humans , Male , Regression Analysis , Stroke Volume/physiology , Survival Analysis , Survival Rate , Time Factors , Treatment Outcome , Ventricular Dysfunction, Left/physiopathologyABSTRACT
Adjuvant medical therapy plays a central role in the ongoing care of patients with coronary artery disease after percutaneous revascularization. The cardiac and vascular protective effects of angiotensin converting enzyme (ACE) inhibitors make these agents an attractive choice in this setting, especially in light of the HOPE study results. Mounting evidence suggests that ACE inhibitors exert their favorable effects at the cellular level by antagonizing angiotensin II and enhancing nitric oxide bioavailability and, in the process, restoring normal endothelial function.
