Ann Rehabil Med.  2015 Apr;39(2):191-198. 10.5535/arm.2015.39.2.191.

Effect of Enhanced External Counterpulsation and Cardiac Rehabilitation on Quality of Life, Plasma Nitric Oxide, Endothelin 1 and High Sensitive CRP in Patients With Coronary Artery Disease: A Pilot Study

• Shakouri S
• Razavi Z
• Eslamian F
• Sadeghi-Bazargani H
• Ghaffari S
• Babaei-Ghazani A

• KMID: 2273040
• DOI: http://doi.org/10.5535/arm.2015.39.2.191

Abstract

OBJECTIVE
To investigate the effect of enhanced external counterpulsation (EECP) on plasma nitric oxide (NO), Endothelin 1 (ET1), high sensitive C-reactive protein (HSCRP) and quality of life (QoL) in patients with coronary artery disease (CAD).
METHODS
We conducted a pilot randomized clinical trial in order to evaluate plasma NO, ET1, HSCRP and QoL before and after twenty sessions of EECP (group A) and cardiac rehabilitation (CR, group B) in 42 patients with CAD (21 in each group).
RESULTS
Forty-two patients (33 male and 9 female) were included in the study. The mean age was 58.2+/-10 years. The mean HSCRP was 1.52+/-0.7 in the EECP group and it was reduced to 1.27+/-0.4 after intervention. The reduction in HSCRP was not statistically significant in EECP and CR groups with p=0.33 and p=0.27, respectively. There was not significant improvement of NO, ET1, and QoL in the EECP and CR groups shortly after therapy (p>0.05).
CONCLUSION
Although the short-term EECP treatment in CAD patients improved HSCRP, NO, ET1, and QoL compared with the baseline those improvements are not statistically significant. Further studies are necessary with large study groups and more sessions.

Keyword

Enhanced external counter pulsation (EECP); Coronary artery disease; Nitric oxide; Endothelins; High-sensitivity C-reactive protein

MeSH Terms

C-Reactive Protein
Coronary Artery Disease*
Counterpulsation*
Endothelin-1*
Endothelins
Humans
Male
Nitric Oxide*
Pilot Projects*
Plasma*
Quality of Life*
Rehabilitation*
C-Reactive Protein
Endothelin-1
Endothelins
Nitric Oxide

Reference

1. Soran O, Ikizler C, Sengul A, Cuglan B, Kennard E, Kelsey S. Comparison of long term clinical outcomes, event free survival rates of patients undergoing enhanced external counterpulsation for coronary artery disease in the United States and Turkey. Turk Kardiyol Dern Ars. 2012; 40:323–330. PMID: 22951848.

2. Kim C, Youn JE, Choi HE. The effect of a self exercise program in cardiac rehabilitation for patients with coronary artery disease. Ann Rehabil Med. 2011; 35:381–387. PMID: 22506148.

3. Loh PH, Kennard E, Bourantas CV, Chelliah R, Atkin P, Cook J, et al. The effectiveness of enhanced external counterpulsation (EECP) in patients suffering from chronic refractory angina previously treated with transmyocardial laser revascularisation. Int J Cardiol. 2013; 168:4383–4385. PMID: 23714590.

4. Ruangkanchanasetr P, Mahanonda N, Raungratanaamporn O, Ruckpanich P, Kitiyakara C, Chaiprasert A, et al. Effect of enhanced external counterpulsation treatment on renal function in cardiac patients. BMC Nephrol. 2013; 14:193. PMID: 24021027.

5. Milani RV, Lavie CJ, Mehra MR. Reduction in C-reactive protein through cardiac rehabilitation and exercise training. J Am Coll Cardiol. 2004; 43:1056–1061. PMID: 15028366.

6. Saini V, Bhatnagar MK, Bhattacharjee J. Association of endothelial dysfunction with endothelin, nitric oxide and eNOS Glu298Asp gene polymorphism in coronary artery disease. Dis Markers. 2011; 31:215–222. PMID: 22045428.

7. Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B. The Short Form Health Survey (SF-36): translation and validation study of the Iranian version. Qual Life Res. 2005; 14:875–882. PMID: 16022079.

8. Rifai N, Tracy RP, Ridker PM. Clinical efficacy of an automated high-sensitivity C-reactive protein assay. Clin Chem. 1999; 45:2136–2141. PMID: 10585345.

9. Eftekhar Sadat B, Khadem Haghighian M, Alipoor B, Malek Mahdavi A, Asghari Jafarabadi M, Moghaddam A. Effects of sesame seed supplementation on clinical signs and symptoms in patients with knee osteoarthritis. Int J Rheum Dis. 2013; 16:578–582. PMID: 24164846.

10. Braith RW, Conti CR, Nichols WW, Choi CY, Khuddus MA, Beck DT, et al. Enhanced external counterpulsation improves peripheral artery flow-mediated dilation in patients with chronic angina: a randomized sham-controlled study. Circulation. 2010; 122:1612–1620. PMID: 20921442.

11. Bonetti PO, Barsness GW, Keelan PC, Schnell TI, Pumper GM, Kuvin JT, et al. Enhanced external counterpulsation improves endothelial function in patients with symptomatic coronary artery disease. J Am Coll Cardiol. 2003; 41:1761–1768. PMID: 12767662.

12. Bonetti PO, Holmes DR Jr, Lerman A, Barsness GW. Enhanced external counterpulsation for ischemic heart disease: what's behind the curtain? J Am Coll Cardiol. 2003; 41:1918–1925. PMID: 12798558.

13. Braverman DL. Enhanced external counterpulsation: a novel therapy for angina. Complement Ther Clin Pract. 2012; 18:197–203. PMID: 23059432.

14. Feldman AM, Silver MA, Francis GS, Abbottsmith CW, Fleishman BL, Soran O, et al. Enhanced external counterpulsation improves exercise tolerance in patients with chronic heart failure. J Am Coll Cardiol. 2006; 48:1198–1205. PMID: 16979005.

15. Liu R, Liang ZJ, Liao XX, Hu CL, Jiang L, Dai G, et al. Enhanced external counterpulsation improves cerebral blood flow following cardiopulmonary resuscitation. Am J Emerg Med. 2013; 31:1638–1645. PMID: 24060327.

16. Lin W, Xiong L, Han J, Leung TW, Soo YO, Chen X, et al. External counterpulsation augments blood pressure and cerebral flow velocities in ischemic stroke patients with cerebral intracranial large artery occlusive disease. Stroke. 2012; 43:3007–3011. PMID: 22996956.

17. Braverman DL, Braitman L, Figueredo VM. The safety and efficacy of enhanced external counterpulsation as a treatment for angina in patients with aortic stenosis. Clin Cardiol. 2013; 36:82–87. PMID: 23109041.

18. Ferreiros ER, Boissonnet CP, Pizarro R, Merletti PF, Corrado G, Cagide A, et al. Independent prognostic value of elevated C-reactive protein in unstable angina. Circulation. 1999; 100:1958–1963. PMID: 10556221.

19. Cooke JP. Role of nitric oxide in progression and regression of atherosclerosis. West J Med. 1996; 164:419–424. PMID: 8686299.

20. Heffernan KS, Jae SY, Vieira VJ, Iwamoto GA, Wilund KR, Woods JA, et al. C-reactive protein and cardiac vagal activity following resistance exercise training in young African-American and white men. Am J Physiol Regul Integr Comp Physiol. 2009; 296:R1098–R1105. PMID: 19193941.