Document Detail

Enhanced external counterpulsation improves peripheral artery flow-mediated dilation in patients with chronic angina: a randomized sham-controlled study.
MedLine Citation:
PMID:  20921442     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Mechanisms responsible for anti-ischemic benefits of enhanced external counterpulsation (EECP) remain unknown. This was the first randomized sham-controlled study to investigate the extracardiac effects of EECP on peripheral artery flow-mediated dilation.
METHODS AND RESULTS: Forty-two symptomatic patients with coronary artery disease were randomized (2:1 ratio) to thirty-five 1-hour sessions of either EECP (n=28) or sham EECP (n=14). Flow-mediated dilation of the brachial and femoral arteries was performed with the use of ultrasound. Plasma levels of nitrate and nitrite, 6-keto-prostaglandin F(1α), endothelin-1, asymmetrical dimethylarginine, tumor necrosis factor-α, monocyte chemoattractant protein-1, soluble vascular cell adhesion molecule, high-sensitivity C-reactive protein, and 8-isoprostane were measured. EECP increased brachial (+51% versus +2%) and femoral (+30% versus +3%) artery flow-mediated dilation, the nitric oxide turnover/production markers nitrate and nitrite (+36% versus +2%), and 6-keto-prostaglandin F(1α) (+71% versus +1%), whereas it decreased endothelin-1 (-25% versus +5%) and the nitric oxide synthase inhibitor asymmetrical dimethylarginine (-28% versus +0.2%) in treatment versus sham groups, respectively (all P<0.05). EECP decreased the proinflammatory cytokines tumor necrosis factor-α (-16% versus +12%), monocyte chemoattractant protein-1 (-13% versus +0.2%), soluble vascular cell adhesion molecule-1 (-6% versus +1%), high-sensitivity C-reactive protein (-32% versus +5%), and the lipid peroxidation marker 8-isoprostane (-21% versus +1.3%) in treatment versus sham groups, respectively (all P<0.05). EECP reduced angina classification (-62% versus 0%; P<0.001) in treatment versus sham groups, respectively.
CONCLUSIONS: Our findings provide novel mechanistic evidence that EECP has a beneficial effect on peripheral artery flow-mediated dilation and endothelial-derived vasoactive agents in patients with symptomatic coronary artery disease.
Randy W Braith; C Richard Conti; Wilmer W Nichols; Calvin Y Choi; Matheen A Khuddus; Darren T Beck; Darren P Casey
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural     Date:  2010-10-04
Journal Detail:
Title:  Circulation     Volume:  122     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-19     Completed Date:  2010-11-05     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1612-20     Citation Subset:  AIM; IM    
Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL 32611, USA.
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MeSH Terms
6-Ketoprostaglandin F1 alpha / blood
Angina Pectoris / physiopathology*
Blood Pressure / physiology
Brachial Artery / physiology*
C-Reactive Protein / metabolism
Chronic Disease
Counterpulsation / methods*
Cytokines / blood
Endothelin-1 / blood
Exercise Tolerance / physiology
Femoral Artery / physiology*
Middle Aged
Nitric Oxide / blood
Oxygen Consumption / physiology
Regional Blood Flow / physiology*
Tumor Necrosis Factor-alpha / blood
Vasodilation / physiology*
Grant Support
Reg. No./Substance:
0/Cytokines; 0/Endothelin-1; 0/Tumor Necrosis Factor-alpha; 10102-43-9/Nitric Oxide; 58962-34-8/6-Ketoprostaglandin F1 alpha; 9007-41-4/C-Reactive Protein
Comment In:
Circulation. 2011 Jun 14;123(23):e631   [PMID:  21670237 ]

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