Enhanced external counterpulsation improves peripheral artery flow-mediated dilation in patients with chronic angina: A randomized sham-controlled study

Randy W. Braith, C. Richard Conti, Wilmer W. Nichols, Calvin Y. Choi, Matheen A. Khuddus, Darren T. Beck, Darren P. Casey

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Abstract

BACKGROUND - Mechanisms responsible for anti-ischemic benefits of enhanced external counterpulsation (EECP) remain unknown. This was the first randomized sham-controlled study to investigate the extracardiac effects of EECP on peripheral artery flow-mediated dilation. METHODS AND RESULTS-: Forty-two symptomatic patients with coronary artery disease were randomized (2:1 ratio) to thirty-five 1-hour sessions of either EECP (n=28) or sham EECP (n=14). Flow-mediated dilation of the brachial and femoral arteries was performed with the use of ultrasound. Plasma levels of nitrate and nitrite, 6-keto-prostaglandin F1α, endothelin-1, asymmetrical dimethylarginine, tumor necrosis factor-α, monocyte chemoattractant protein-1, soluble vascular cell adhesion molecule, high-sensitivity C-reactive protein, and 8-isoprostane were measured. EECP increased brachial (+51% versus +2%) and femoral (+30% versus +3%) artery flow-mediated dilation, the nitric oxide turnover/production markers nitrate and nitrite (+36% versus +2%), and 6-keto-prostaglandin F1α (+71% versus +1%), whereas it decreased endothelin-1 (-25% versus +5%) and the nitric oxide synthase inhibitor asymmetrical dimethylarginine (-28% versus +0.2%) in treatment versus sham groups, respectively (all P<0.05). EECP decreased the proinflammatory cytokines tumor necrosis factor-α (-16% versus +12%), monocyte chemoattractant protein-1 (-13% versus +0.2%), soluble vascular cell adhesion molecule-1 (-6% versus +1%), high-sensitivity C-reactive protein (-32% versus +5%), and the lipid peroxidation marker 8-isoprostane (-21% versus +1.3%) in treatment versus sham groups, respectively (all P<0.05). EECP reduced angina classification (-62% versus 0%; P<0.001) in treatment versus sham groups, respectively. CONCLUSIONS-: Our findings provide novel mechanistic evidence that EECP has a beneficial effect on peripheral artery flow-mediated dilation and endothelial-derived vasoactive agents in patients with symptomatic coronary artery disease.

Original languageEnglish (US)
Pages (from-to)1612-1620
Number of pages9
JournalCirculation
Volume122
Issue number16
DOIs
StatePublished - Oct 19 2010

Fingerprint

Counterpulsation
Dilatation
Arteries
8-epi-prostaglandin F2alpha
Vascular Cell Adhesion Molecule-1
Chemokine CCL2
Placebos
Endothelin-1
Nitrites
Nitrates
C-Reactive Protein
Coronary Artery Disease
Tumor Necrosis Factor-alpha
Brachial Artery
Proxy
Femoral Artery
Thigh
Nitric Oxide Synthase
Lipid Peroxidation
Nitric Oxide

Keywords

  • angina
  • endothelin
  • inflammation
  • nitric oxide
  • vasodilation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Enhanced external counterpulsation improves peripheral artery flow-mediated dilation in patients with chronic angina : A randomized sham-controlled study. / Braith, Randy W.; Conti, C. Richard; Nichols, Wilmer W.; Choi, Calvin Y.; Khuddus, Matheen A.; Beck, Darren T.; Casey, Darren P.

In: Circulation, Vol. 122, No. 16, 19.10.2010, p. 1612-1620.

Research output: Contribution to journalArticle

Braith, Randy W. ; Conti, C. Richard ; Nichols, Wilmer W. ; Choi, Calvin Y. ; Khuddus, Matheen A. ; Beck, Darren T. ; Casey, Darren P. / Enhanced external counterpulsation improves peripheral artery flow-mediated dilation in patients with chronic angina : A randomized sham-controlled study. In: Circulation. 2010 ; Vol. 122, No. 16. pp. 1612-1620.
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AU - Choi, Calvin Y.

AU - Khuddus, Matheen A.

AU - Beck, Darren T.

AU - Casey, Darren P.

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N2 - BACKGROUND - Mechanisms responsible for anti-ischemic benefits of enhanced external counterpulsation (EECP) remain unknown. This was the first randomized sham-controlled study to investigate the extracardiac effects of EECP on peripheral artery flow-mediated dilation. METHODS AND RESULTS-: Forty-two symptomatic patients with coronary artery disease were randomized (2:1 ratio) to thirty-five 1-hour sessions of either EECP (n=28) or sham EECP (n=14). Flow-mediated dilation of the brachial and femoral arteries was performed with the use of ultrasound. Plasma levels of nitrate and nitrite, 6-keto-prostaglandin F1α, endothelin-1, asymmetrical dimethylarginine, tumor necrosis factor-α, monocyte chemoattractant protein-1, soluble vascular cell adhesion molecule, high-sensitivity C-reactive protein, and 8-isoprostane were measured. EECP increased brachial (+51% versus +2%) and femoral (+30% versus +3%) artery flow-mediated dilation, the nitric oxide turnover/production markers nitrate and nitrite (+36% versus +2%), and 6-keto-prostaglandin F1α (+71% versus +1%), whereas it decreased endothelin-1 (-25% versus +5%) and the nitric oxide synthase inhibitor asymmetrical dimethylarginine (-28% versus +0.2%) in treatment versus sham groups, respectively (all P<0.05). EECP decreased the proinflammatory cytokines tumor necrosis factor-α (-16% versus +12%), monocyte chemoattractant protein-1 (-13% versus +0.2%), soluble vascular cell adhesion molecule-1 (-6% versus +1%), high-sensitivity C-reactive protein (-32% versus +5%), and the lipid peroxidation marker 8-isoprostane (-21% versus +1.3%) in treatment versus sham groups, respectively (all P<0.05). EECP reduced angina classification (-62% versus 0%; P<0.001) in treatment versus sham groups, respectively. CONCLUSIONS-: Our findings provide novel mechanistic evidence that EECP has a beneficial effect on peripheral artery flow-mediated dilation and endothelial-derived vasoactive agents in patients with symptomatic coronary artery disease.

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KW - endothelin

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