Improvement of fractional flow reserve and collateral flow by treatment with external counterpulsation (Art.Net.-2 Trial).
BACKGROUND
Arteriogenesis (collateral artery growth) is nature's most efficient rescue mechanism to overcome the fatal consequences of arterial occlusion or stenosis. The goal of this trial was to investigate the effect of external counterpulsation (ECP) on coronary collateral artery growth.


METHODS
A total of 23 patients (age 61 +/- 2.5 years) with stable coronary artery disease and at least one haemodynamic significant stenosis eligible for percutaneous coronary intervention were prospectively recruited into the two study groups in a 2 : 1 manner (ECP : control). One group (ECP group, n = 16) underwent 35 1-h sessions of ECP in 7 weeks. In the control group (n = 7), the natural course of collateral circulation over 7 weeks was evaluated. All patients underwent a cardiac catheterization at baseline and after 7 weeks, with invasive measurements of the pressure-derived collateral flow index (CFIp, primary endpoint) and fractional flow reserve (FFR).


RESULTS
In the ECP group, the CFIp (from 0.08 +/- 0.01 to 0.15 +/- 0.02; P < 0.001) and FFR (from 0.68 +/- 0.03 to 0.79 +/- 0.03; P = 0.001) improved significantly, while in the control group no change was observed. Only the ECP group showed a reduction of the Canadian Cardiovascular Society (CCS, P = 0.008) and New York Heart Association (NYHA, P < 0.001) classification.


CONCLUSIONS
In this study, we provide direct functional evidence for the stimulation of coronary arteriogenesis via ECP in patients with stable coronary artery disease. These data might open a novel noninvasive and preventive treatment avenue for patients with non-acute vascular stenotic disease.
Buschmann
E E
EE
Franz-Volhard-Klinik, Department for Cardiology, Helios-Klinikum Buch, Berlin, Germany. eva_elina.buschmann@charite.de
Utz
W
W
Pagonas
N
N
Schulz-Menger
J
J
Busjahn
A
A
Monti
J
J
Maerz
W
W
le Noble
F
F
Thierfelder
L
L
Dietz
R
R
Klauss
V
V
Gross
M
M
Buschmann
I R
IR
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology*; D003097:Collateral Circulation / Q000502:physiology*; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015908:Counterpulsation / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged