[Novel possibilities in the treatment of patients with heart failure. The method of external counterpulsation].

AIM OF THE WORK

To assess effect of programmed external counterpulsation (ECP) on clinico-functional status, quality of life of patients with chronic heart failure (CHF) of ischemic origin, stable functional class (FC) II-IV angina refractory to drug therapy.

MATERIAL AND METHODS

Patients (n=30) with ischemic heart disease (IHD) stable FC II-IV angina (mean age 65.5 +/- 7.9 years) went though complete curative course of ECP which included 35 1-hour procedures 5-6 times a week. Signs of CHF NYHA FC I-II were noted in 18, FC III-IV - in 12 patients. In 8 patients left ventricular (LV) ejection fraction (EF) did not exceed 35%. Methods of investigation used before and after course of ECP included clinical examination, echoCG, VEM-test, perfusion myocardial scintigraphy with 99MTc-MIBI, 24-hour ECG monitoring, assessment of quality of life with the use of Minnesota questionnaire and of dynamics of plasma content of natriuretic peptides (pro-ANP and pro-BNP) measured by immunoenzyme assay.

RESULTS

Absolute majority of patients noted improvement of self feeling with significant (p < 0.001) betterment of parameters of quality of life. Number of attacks of angina and nitrate requirement decreased more than two times. Significantly (p < 0.01) rose tolerance to physical work load. In most patients decreases of depth and extent of myocardial perfusion defects were noted. With this positive dynamics of functional status, quality of life and severity of angina was noted irrespective of manifestations of heart failure and degree of suppression of LV contractile function. Significant (p < 0.001) improvement of contractile function of the myocardium according to data of echoCG was noted predominantly in patients with initial LVEF < 35%. According to data of 24-hour ECG monitoring significant (p < 0.01) decrease of average heart rate was also noted.

CONCLUSION

The obtained results evidence for high efficacy and safety of ECP in complex treatment of patients with CHF of ischemic origin with resistant to drug therapy angina pectoris.