Werner Dierk, Kropp Joachim, Schellong Sebastian, Friedel Chris, Voigt Jens-Uwe, Ludwig Josef, Daniel Werner G, Flachskampf Frank A
Department of Cardiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
Clin Cardiol. 2003 Nov;26(11):525-9. doi: 10.1002/clc.4960261110.
An increasing number of clinical studies indicates reduction of angina and myocardial ischemia by enhanced external counterpulsation (EECP) therapy. However, given the wide range of contraindications and the long duration of treatment, eligibility and practicality issues have not been addressed systematically.
Of all candidates for EECP (patients with drug-refractory angina without possibility of revascularization), the majority either have contraindications or have practical problems complying with the time demands that this therapy imposes. In the rest, EECP leads to satisfactory results.
During 18 months, every consecutive patient with angina despite medical and interventional therapy was evaluated for EECP at one center. Treated patients underwent a bicycle exercise test and perfusion imaging before and after the standard course of 35 h of EECP. In addition, patients were asked about frequency of angina and nitroglycerin usage before and after EECP, and all patients filled out a final questionnaire 1 year after the end of therapy.
Overall, 48 patients were considered candidates for EECP. Of these, 24 were excluded for medical reasons: poor ejection fraction (4), peripheral artery disease (4), anticoagulation (4), and atrial fibrillation (3). Eight further patients declined EECP for lack of time or accommodation. Another 3 of the 16 remaining patients dropped out because of side effects. In the 13 patients who finished the treatment course, weekly anginal episodes were reduced by 48% (p < 0.05), on-demand nitroglycerin puffs were reduced by 51% (p < 0.05), work capacity was improved by 22% (p < 0.05), and the number of reversible perfusion defects in perfusion scans decreased nonsignificantly (-28%). However, 4 of 13 treated patients determined 1 year later that the detriment of loss of time exceeded the benefits of EECP.
Similar to previous reports, our study confirms the reduction of angina and improvement of work capacity after EECP. However, using established contraindications, approximately two-thirds of patients considered to be candidates had to be excluded, and one-third of the treated patients regarded EECP therapy retrospectively as too time consuming.
越来越多的临床研究表明，增强型体外反搏（EECP）疗法可减轻心绞痛和心肌缺血。然而，鉴于其广泛的禁忌症和较长的治疗时间， eligibility和实用性问题尚未得到系统解决。
在所有EECP候选者（药物难治性心绞痛且无法进行血运重建的患者）中，大多数要么有禁忌症，要么在遵守该疗法所需的时间要求方面存在实际问题。其余患者中，EECP可取得满意结果。
在18个月期间，在一个中心对每一位尽管接受了药物和介入治疗仍有心绞痛的连续患者进行EECP评估。接受治疗的患者在35小时标准疗程的EECP前后进行了自行车运动试验和灌注成像。此外，询问患者EECP前后心绞痛发作频率和硝酸甘油使用情况，所有患者在治疗结束1年后填写了一份最终问卷。
总体而言，48例患者被视为EECP候选者。其中，24例因医学原因被排除：射血分数低（4例）、外周动脉疾病（4例）、抗凝治疗（4例）和心房颤动（3例）。另外8例患者因时间或住宿问题拒绝接受EECP。其余16例患者中有3例因副作用退出。在完成治疗疗程的13例患者中，每周心绞痛发作次数减少了48%（p<0.05），按需使用硝酸甘油喷雾减少了51%（p<0.05），工作能力提高了22%（p<0.05），灌注扫描中可逆灌注缺损的数量无显著减少（-28%）。然而，13例接受治疗的患者中有4例在1年后确定，时间损失的不利影响超过了EECP的益处。
与之前的报告相似，我们的研究证实了EECP后心绞痛减轻和工作能力改善。然而，根据既定的禁忌症，约三分之二被视为候选者的患者必须被排除，三分之一的接受治疗的患者事后认为EECP治疗过于耗时。
