Effects of enhanced external counter pulsation on endothelial function and antithrombogenic activity of vascular endothelium in patients with angina

Abstract

Purpose: To study the antianginal effect of EECP and its effect on endothelial function in patients with coronary artery disease and stable angina II-III class (FC). Methods: Open randomized controlled study was performed with parallel comparison groups in which included 35 patients (30 men and 5 women), age 59±8,6 years, with stable angina FC II-III. The patients were divided into two groups: Group 1 included 22 men who underwent 35 sessions of active EECP. The pressure generated in cuffs was 240-280 mm Hg. In Group 2 – sham control group was included 13 people who were also held sessions of EECP, only the cuff pressure was 120 mm Hg. The groups were comparable for demographic, clinical and history characteristics. Effect of EECP on endothelial function was assessed by tests described D. Celermajer. Plasma levels of von Willebrand factor was quantified by ristomitsin, level of antithrombin III (AT III), plasminogen and protein C - using a chromogenic substrate for the analyzer. Antigen tissue plasminogen activator (t-PA) and tissue plasminogen activator inhibitor (PAI-1) was measured by ELISA. Results: Significant improvement in exercise capacity: increased exercise capacity, the total duration of exercise test, and time to onset of symptoms and signs of myocardial ischemia according to bicycle ergometry was found in Group I. In 76.67% pts had endothelial dysfunction (ED). Frequency of ED was similar in both groups. EECP treatment improved flow mediate vasodilation in the group I: increasing% dilatation in brachial artery, the absolute maximum increase in brachial artery diameter. In the control group, significant changes were not found. After treatment, there was a significant increase in AT III and plasminogen, and decreased PAI-1 in the group I. There was a trend to an increase in protein C in the study group. In the sham-control group, the level of laboratory markers of ED was not significantly changed. Significant dynamics on the level of von Willebrand factor, tissue plasminogen activator have been reported. Conclusion: EECP is an effective non-invasive treatment out-patient with significant antianginal effect. EECP improves endothelial function with activation of antithrombogenic activity of vessel wall.