Soran Ozlem, Kennard Elizabeth D, Kelsey Sheryl F, Holubkov Richard, Strobeck John, Feldman Arthur M
Cardiovascular Institute, UPMC Health System, Pittsburgh, PA, USA.
Congest Heart Fail. 2002 Nov-Dec;8(6):297-302. doi: 10.1111/j.1527-5299.2002.00286.x.
The International Enhanced External Counterpulsation (EECP) Patient Registry tracks acute and long-term outcome for consecutive patients treated for chronic angina. Although EECP has previously been shown to be a safe and effective treatment for angina, little information is available on its use in patients with left ventricular (LV) dysfunction. This report compares the acute outcome and 6-month follow-up for a group of patients with severe LV dysfunction and a group of patients without LV dysfunction. Of 1,402 patients in the registry recruited in 1998-1999 who had recorded values of LV ejection fraction (LVEF) at baseline, 1,090 (77.7%) had preserved LV function (LVEF >35%) and 312 (22.3%) had LV dysfunction (LVEF </=35%). Six-month follow-up was available on 84% of these patients. Pre-EECP patients with LV dysfunction had a longer history of coronary artery disease (12.9 years vs. 9.1 years; p<0.001), a higher rate of congestive heart failure (60.6% vs. 20.1%; p<0.001) and myocardial infarction (83.5% vs. 61.9%; p<0.001). Patients with LV dysfunction had more severe pre-EECP angina, with 86.2% presenting with Canadian Cardiovascular Society Class III/IV vs. 73.6%; p<0.01. Patients with LV dysfunction, consistent with their more severe baseline profile, suffered more adverse events (death, unstable angina, and exacerbation of heart failure) during the treatment period and were less likely to complete the full course. Immediately post-EECP, angina decreased by at least one class in 67.8% of patients with LV dysfunction (vs. 76.2%; p<0.01), and 35.9% of LV dysfunction patients vs. 39.0% had discontinued nitroglycerin use (p=ns). At 6-month follow-up, patients with LV dysfunction showed higher rates of death (9.3% vs. 2.2%; p<0.001) and exacerbation of congestive heart failure (9.9% vs. 3.7%; p<0.001). Rates of the composite outcome of death/myocardial infarction/coronary artery bypass grafting/percutaneous coronary intervention (15.4% vs. 8.3%; p<0.001) were also higher for patients with LV dysfunction. However, patients not reporting such an event showed maintenance of their improved anginal status, with 81% of LV dysfunction vs. 83.8% of patients without LV dysfunction (p=ns) reporting angina at 6 months equal to or less severe than immediately post-EECP, and nitroglycerin use was still reduced at 46.1% for LV dysfunction vs. 37.4% (p<0.05). The rate of event-free angina maintenance at 6 months was 67.0% for patients with LV dysfunction and 70.6% of patients with preserved LV function (p=ns). Patients with LV dysfunction achieved a less robust reduction in angina than did those without LV dysfunction. For the majority of the patients in the registry, this reduction was maintained at 6 months.
国际增强型体外反搏（EECP）患者注册系统追踪接受慢性心绞痛治疗的连续患者的急性和长期预后。尽管此前已证明EECP是治疗心绞痛的一种安全有效的方法，但关于其在左心室（LV）功能不全患者中的应用信息却很少。本报告比较了一组严重LV功能不全患者和一组无LV功能不全患者的急性预后和6个月随访情况。在1998 - 1999年注册的1402例患者中，有1090例（77.7%）基线时左心室射血分数（LVEF）正常（LVEF>35%），312例（22.3%）存在LV功能不全（LVEF≤35%）。这些患者中有84%进行了6个月的随访。LV功能不全的EECP治疗前患者冠心病病史更长（12.9年对9.1年；p<0.001），充血性心力衰竭发生率更高（60.6%对20.1%；p<0.001），心肌梗死发生率更高（83.5%对61.9%；p<0.001）。LV功能不全的患者EECP治疗前心绞痛更严重，86.2%为加拿大心血管学会III/IV级，而无LV功能不全患者为73.6%；p<0.01。LV功能不全的患者，与其更严重的基线情况一致，在治疗期间发生更多不良事件（死亡、不稳定型心绞痛和心力衰竭加重），且完成整个疗程的可能性更小。EECP治疗后即刻，LV功能不全患者中67.8%的心绞痛至少减轻一级（无LV功能不全患者为76.2%；p<0.01），LV功能不全患者中35.9%停用硝酸甘油，无LV功能不全患者为39.0%（p=无显著差异）。在6个月随访时，LV功能不全患者的死亡率（9.3%对2.2%；p<0.001）和充血性心力衰竭加重率（9.9%对3.7%；p<0.001）更高。LV功能不全患者死亡/心肌梗死/冠状动脉搭桥术/经皮冠状动脉介入治疗的复合结局发生率也更高（15.4%对8.3%；p<0.001）。然而，未报告此类事件的患者心绞痛状况得到改善，LV功能不全患者中有81%、无LV功能不全患者中有83.8%报告6个月时心绞痛程度等于或轻于EECP治疗后即刻，LV功能不全患者硝酸甘油使用率仍降至46.1%，无LV功能不全患者为37.4%（p<0.05）。LV功能不全患者6个月时无事件性心绞痛维持率为67.0%，LV功能正常患者为70.6%（p=无显著差异）。LV功能不全患者心绞痛减轻程度不如无LV功能不全患者明显。对于注册系统中的大多数患者，这种减轻在6个月时得以维持。
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