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The effect of external counterpulsation on intrinsic myocardial function evaluated by speckle tracking echocardiography in refractory angina patients: a randomized controlled trial

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Abstract

External Counterpulsation (ECP) is one of the therapeutic options in patients with refractory angina inadequately controlled by medical, interventional, or surgical therapy. The 2D Speckle Tracking Echocardiography (2D-STE) method is considered superior in assessing clinical improvement. We would like to evaluate any improvement of myocardial intrinsic function using 2D-STE in patients underwent standard ECP protocol (35 sessions). We conducted a double-blind randomized controlled trial. Patients with refractory angina who could not be revascularized conventionally were randomized into two groups: (1) the ECP group (300 mmHg) and (2) the Sham/control group (75 mmHg). ECP standard therapy was given for 35 sessions (1 h/day/session). The 2D-STE data, including longitudinal strain and post systolic index (PSI) were obtained before and after therapy. 43 subjects were analyzed, with 22 subjects in ECP group and 21 control subjects (Sham group). A homogenous baseline strain was found either globally (12.42 ± 4.55 vs 12.00 ± 4.92 [− %]; P = 0.774) or segmentally/regionally (12.63 (0.01–25.16) vs 12.43 (0.01–27.20) [− %]; P = 0.570). There was no statistically significant improvement between groups in the left ventricle longitudinal strain globally (P = 0.535) and segmentally/regionally (P = 0.434). PSI parameters showed improvement in the ECP group (P = 0.049), and segments with PSI ≥ 20% seemed to improve longitudinal strains in the ECP group after therapy (P = 0.042). In conclusion, 35 ECP therapy sessions did not improve either global or segmental/regional left ventricular mechanical function in patients with refractory angina. However, the mechanical function of myocardial segments with PSS tends to improve after ECP therapy.

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Abbreviations

2D-STE:

2-Dimensional Speckle-Tracking Echocardiography

AVC:

Aortic Valve Closure

CAD:

Coronary Artery Disease

CABG:

Coronary Artery Bypass Graft

CCS:

Canadian Cardiovascular Society

D/S ratio:

Diastolic/Systolic Peak Ratio

CAD3VD:

Coronary Artery Disease 3 Vessels Disease

ECP:

External Counterpulsation

EDD:

End-Diastolic Diameter

ESD:

Left Ventricle End-Systolic Diameter

LAD:

Left Anterior Descending

LM:

Left Main

LV:

Left Ventricular

LVEF:

Left Ventricular Ejection Fraction

PCI:

Percutaneous coronary intervention

PSI:

Post-systolic Index

PSS:

Post-systolic Shortening

SPECT:

Single-Photon Emission Computed Tomography

TAPSE:

Tricuspid Annular Plane Systolic Excursion

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Funding

This study was funded by a Riset Unggulan Harapan Kita award, a program to support clinical research by National Cardiovascular Center Harapan Kita.

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Authors and Affiliations

  1. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia

    Dexanda Pravian, Amiliana M. Soesanto, Ade M. Ambari, B. R. M. Ario S. Kuncoro, Bambang Dwiputra, Hary S. Muliawan & Renan Sukmawan

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  1. Dexanda Pravian
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  2. Amiliana M. Soesanto
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  3. Ade M. Ambari
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  4. B. R. M. Ario S. Kuncoro
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  6. Hary S. Muliawan
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  7. Renan Sukmawan
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Corresponding author

Correspondence to Amiliana M. Soesanto.

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Conflict of interest

Ade M Ambari, MD, received an ECP device for this study from SimaxMed®. The funders had no role in the study’s design, the collection, analysis, or interpretation of data, the report’s writing, or the decision to submit the article for publication.

Ethical approval

All procedures performed in studies involving human participants conform to the institutional and/or national research committee’s ethical standards and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards as reflected in a priori approval by the National Cardiovascular Center Harapan Kita Institutional Review Board.

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Informed consent was obtained from all individual participants included in the study.

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Pravian, D., Soesanto, A.M., Ambari, A.M. et al. The effect of external counterpulsation on intrinsic myocardial function evaluated by speckle tracking echocardiography in refractory angina patients: a randomized controlled trial. Int J Cardiovasc Imaging 37, 2483–2490 (2021). https://doi.org/10.1007/s10554-021-02289-x

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