Abstract 12028: Deranged Renal Functions Improve After Enhanced External Counter Pulsation Therapy in Patients With Chronic Ischemic Heart Disease

Abstract

Introduction: Renal dysfunction frequently occurs in patients with coronary artery disease (CAD) significantly limiting their therapeutic options. Enhanced External Counter Pulsation (EECP) therapy improves symptomatic status and cardiac function in patients with CAD; however it’s impact on concomitant renal dysfunction is not well understood. Hypothesis: EECP therapy could improve renal function by improving LV systolic function and subsequently the renal perfusion. Methods: Patients with CAD referred to our EECP lab having baseline calculated glomerular filtration rate (GFR) less than 60ml/min were included in the study. All patients were subjected to 35 EECP sessions of one hour each. A thorough clinical evaluation, echocardiography, 6 min hall walk test and renal function test were done at the baseline and after completion of therapy. GFR was calculated with the help of MDRD (Modification of Diet in Renal Disease) formula. Statistical comparisons were made in renal parameters before and after EECP therapy. Results: Seventy four patients with GFR <60ml/min, mean age 64.5+/-8.7 yrs, 63(92%) males, completed 35 sessions of EECP therapy. Significant improvement was noted in left ventricular ejection fraction (LVEF) (34.8+/-12.4 to 38.8+/-12.3%, P<0.0001), functional class and 6 min hall walk distance (263.4+/-147.8 meters to 403.1+/-96.2 meters, P<0.0001) from baseline to post EECP therapy. GFR increased significantly from 39.5+/-15.1 ml/min at baseline to 46.5 +/- 21.9 ml/min after EECP. The improvement in GFR was more pronounced in the subgroup of 51 patients having baseline LVEF <40%, where 61% patients showed increase in GFR (from mean 40.6+/-14.8 to 48.1 +/- 20.1 ml/min, p= 0.003) after EECP. Blood urea and creatinine also significantly decreased in this group after EECP therapy. Conclusions: Deranged renal function, including reduced GFR, improve significantly after EECP therapy in patients with CAD, especially in those having baseline low LVEF. This beneficial effect of EECP is likely to be due to improvement in renal perfusion secondary to better LV function. Accordingly, EECP could be a potential therapeutic option for stabilizing ischemic heart failure patients with deranged renal function, prior to cardiac interventions.