EECP appears to promote angiogenesis, may explain long-term angina relief
מתוך medicontext.co.il
By Martha Kerr
ANAHEIM, California (Reuters Health) – Enhanced External Counter Pulsation (EECP) has been shown to relieve symptoms of unstable angina for periods of as long as 5 years. A possible explanation is that EECP stimulates the production of angiogenic factors through an increased shear force in the coronary arteries, researchers reported here at the American Heart Association's 2001 scientific sessions.
Results of a study conducted by Dr. Daisuke Maisuda and colleagues at Kyoto University were presented by Dr. William E. Lawson of the State University of New York at Stonybrook, standing in for the Japanese investigators who could not make the meeting this year. AHA officials said attendance is down by about 20% this year from what was expected. Dr. Lawson is one of the original investigators of EECP and author of the first paper on the subject published in the US.
EECP involves the placement of three pneumatic cuffs on each of the lower extremities, which are sequentially inflated during diastole and simultaneously deflated during systole for a 1-hour period, Dr. Lawson explained. The effect is to increase cardiac output and decrease workload. Thirty-five consecutive sessions comprise a treatment.
The Kyoto team studied 11 patients with unstable angina and severe LAD vessel disease. After undergoing EECP, Dr. Lawson said that the time to ST segment elevation on stress testing "literally doubled."
Time to elevation at baseline was 180 seconds. After EECP, it was 375 seconds. Positron emission testing showed changes in motion of the anterior wall, a sign of increased blood flow in that region, Dr. Lawson noted. He said that in his experience, 70% to 80% of patients remain angina-free for as long as 5 years.
Dr. Maisuda and colleagues previously reported the development of functional collateral vessels following EECP. They point out that this can occur only in the presence of angiogenic factors. The investigators show in this study, presented Monday, that hepatocyte growth factor increased significantly (35%) after EECP.
Vascular endothelial growth factor, basic fibroblast growth factor and monocyte chemotactic protein-1 (MCP-1) all increased as well, but in amounts not statistically significant.
Dr. Lawson commented that EECP probably promotes angiogenesis by an increase in shear force in the heart, which stimulates nitric oxide production, which in turn stimulates growth factors.
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