title: Enhanced external counterpulsation for treatment of refractory angina pectoris.
abstract: OBJECTIVE
  Enhanced external counterpulsation (EECP) is a noninvasive, well-tolerated treatment, effective for managing patients with refractory angina pectoris. The aim of this study was to evaluate the efficacy of EECP to relieve symptoms, to decrease myocardial ischaemia and to improve cardiac performance in patients with intractable angina, refractory to surgical and medical treatment.
  
  
  METHODS
  Twenty-five patients (24 men and one woman, mean age 65 years) with persistent ischaemia notwithstanding optimal medical therapy or after interventional or surgical procedure, received EECP sessions for 35 h. Each patient underwent dobutamine stress echocardiography before and after treatment. We evaluated modifications in either cardiac systolic or diastolic function, and in wall motion score index.
  
  
  RESULTS
  Eighty-four percent of patients showed an increase in at least one functional angina class. We did not observe any significant changes in fractional shortening and diastolic function. Thirty-six percent of patients had a reduction in the area of inducible ischaemia at dobutamine stress echocardiography after treatment. Unfortunately, because of the small sample size, we did not find any statistically significant difference. There was a trend showing that patients who benefited the most were those with the worst systolic function and with severely compromised segmental kinesis (P = NS).
  
  
  CONCLUSIONS
  EECP is effective in relieving symptoms in patients with refractory angina and may reduce inducible ischaemia at dobutamine stress echocardiography, especially in patients with reduced systolic function and compromised segmental kinesis.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Cardiovascular and Nephro-Urological Diseases, University of Palermo, Palermo, Italy. pepenovo@hotmail.com
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Novo
authors.forename: Jens Peder
authors.initials: JP
authors.lastname: Bagger
authors.forename: Riccardo
authors.initials: R
authors.lastname: Carta
authors.forename: George
authors.initials: G
authors.lastname: Koutroulis
authors.forename: Roger
authors.initials: R
authors.lastname: Hall
authors.forename: Petros
authors.initials: P
authors.lastname: Nihoyannopoulos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002908:Chronic Disease; D015908:Counterpulsation; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D017202:Myocardial Ischemia / Q000601:surgery; D011788:Quality of Life; D012107:Research Design; D012720:Severity of Illness Index; D013318:Stroke Volume; D016896:Treatment Outcome; D016277:Ventricular Function, Left