Background Enhanced external counterpulsation (EECP) treatment has been shown to improve systemic endovascular and neurohumoral effects. Since diabetic patients (pts) with angina have increased CABG morbidity, more PCI restenosis, more cardiovascular death, and increased mortality in those pts with heart failure (HF), EECP may be a beneficial treatment of angina for diabetic pts with HF.
Purpose Initial and 1-year effects of EECP on angina status, quality of life (QoL), and MACE (death, MI, CABG/PCI) were compared in angina pts with HF vs angina with heart failure and diabetes.
Methods Consecutive angina pts with HF in the International EECP Pt Registry were divided by their diabetic status and prospectively followed for 1 year after EECP. Measures included Canadian Cardiovascular Society (CCS) angina class, nitroglycerin use, QoL, and MACE. Statistical analysis was by chi-square tests, Wilcoxon signed rank tests, and Kaplan Meier survival methods. Significance; p<0.05.
Results There were 779 angina pts with HF, 413 (53%) were diabetic. Diabetic pts were younger (66.3 ± 10.7 vs. 68.9 ± 10.8 years), with more recently diagnosed CAD (11.6 ± 8.5 vs. 13.4 ± 8.8 years), more likely to be female (33.7% vs. 22%), hypertensive (80.0% versus 71.2%), and with less smoking history (70.7% vs. 83%). At baseline, there were no differences in CCS class III and IV, mean LVEF, multivessel CAD, and revascularization candidacy between the two groups. Health-related QoL was significantly worse in the diabetics. Both groups underwent a comparable EECP course, with similar MACE during therapy. Post EECP, diabetic pts had a comparable reduction in angina (72.3% vs. 71.1% achieved one or more CCS class reduction), Ntg use and angina episodes/week. Angina reduction was sustained at 1 year; with no significant differences in Ntg use. Diabetic pts demonstrated significantly greater improvements in health, satisfaction, and quality of life at 12 months. Comparable MACE was noted at 1 year (25.6% vs. 21.8%).
Conclusions EECP effectively relieves angina in HF patients with or without diabetes. Diabetic pts demonstrate comparable sustained improvements in angina class, decreases in anginal episodes and nitroglycerin use, with more improvement in their quality of life. EECP may be a unique therapy in improving endovascular function in patients with atherothrombosis and neurohumoral activation such as the diabetic with HF and angina.
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