Journal Article

Coronary collateral growth by external counterpulsation: a randomised controlled trial

Steck, Hélène, Togni, Mario, de Marchi, Stefano F, Wustmann, Kerstin, Meier, Pascal, Seiler, Christian, Cook, Stéphane, Vogel, Rolf, Rutz, Tobias, Gloekler, Steffen, Traupe, Tobias, Rimoldi, Stefano F

2010

Overview

BackgroundThe efficacy of external counterpulsation (ECP) on coronary collateral growth has not been investigated in a randomised controlled study.ObjectiveTo test the hypothesis that ECP augments collateral function during a 1 min coronary balloon occlusion.Patients and methodsTwenty patients with chronic stable coronary artery disease were studied. Before and after 30 h of randomly allocated ECP (20 90 min sessions over 4 weeks at 300 mm Hg inflation pressure) or sham ECP (same setting at 80 mm Hg inflation pressure), the invasive collateral flow index (CFI, no unit) was obtained in 34 vessels without coronary intervention. CFI was determined by the ratio of mean distal coronary occlusive pressure to mean aortic pressure with central venous pressure subtracted from both. Additionally, coronary collateral conductance (occlusive myocardial blood flow per aorto-coronary pressure drop) was determined by myocardial contrast echocardiography, and brachial artery flow-mediated dilatation was obtained.ResultsCFI changed from 0.125 (0.073; interquartile range) at baseline to 0.174 (0.104) at follow-up in the ECP group (p=0.006), and from 0.129 (0.122) to 0.111 (0.125) in the sham ECP group (p=0.14). Baseline to follow-up change of coronary collateral conductance was from 0.365 (0.268) to 0.568 (0.585) ml/min/100 mm Hg in the ECP group (p=0.072), and from 0.229 (0.212) to 0.305 (0.422) ml/min/100 mm Hg in the sham ECP group (p=0.45). There was a correlation between the flow-mediated dilatation change from baseline to follow-up and the corresponding CFI change (r=0.584, p=0.027).ConclusionsECP appears to be effective in promoting coronary collateral growth. The extent of collateral function improvement is related to the amount of improvement in the systemic endothelial function.

• Publisher: BMJ Publishing Group Ltd and British Cardiovascular Society,BMJ Publishing Group,BMJ Publishing Group LTD
• Subject: Angina pectoris / Angina Pectoris - physiopathology / Angina Pectoris - therapy / Arteriogenesis / Balloon Occlusion / Biological and medical sciences / Cardiology. Vascular system / Chronic Disease / collateral circulation / Collateral Circulation - physiology / coronary artery disease / Coronary Artery Disease - physiopathology / Coronary Artery Disease - therapy / coronary circulation / coronary collateral circulation / coronary haemodynamics / Coronary heart disease / coronary physiology / Counterpulsation - methods / echocardiography-contrast / external counterpulsation / Female / fluid shear stress / Heart / Heart attacks / Hemodynamics / Humans / Male / Medical sciences / Middle Aged / Shear stress