Reduced peripheral vascular reactivity in refractory angina pectoris: Effect of enhanced external counterpulsation

Susanne M Bondesson, Marie-Louise Edvinsson, Thomas Pettersson, Lars Edvinsson, Susanne M Bondesson, Marie-Louise Edvinsson, Thomas Pettersson, Lars Edvinsson

Abstract

Aims: To examine if the skin microvascular bed is altered and can be modified by enhanced external counterpulsation (EECP) in patients with chronic refractory angina.

Methods: Twenty patients diagnosed with refractory angina were divided into EECP (n = 10) or no EECP (n = 10) groups. The data were compared to matched healthy subjects (n = 20). The cutaneous forearm microvascular blood flow was measured by Laser-Doppler flowmetry. The vascular responsiveness to iontophoretic administration of acetylcholine (ACh), sodium nitroprusside (SNP) and local skin warming were studied. Measurements of Canadian Cardiovascular Society (CCS)-class, blood pressure and plasma samples were registered.

Results: EECP patients showed reduced CCS-class compared to no EECP (P < 0.05). Both EECP and no EECP (P < 0.05) groups had decreased systolic blood pressure (SBP) as compared to SBP at baseline (P < 0.05). There was no difference in resting blood flow between the two refractory groups at baseline as well as after EECP and seven weeks of follow-up. Responses to heating, the responses to ACh and SNP in the cutaneous microcirculation were lower in both groups of refractory angina patients as compared to healthy subjects (P < 0.05). EECP patients corresponded positively to the treatment shown by reduced plasma level of soluble interleukin-2 receptor and CCS-class.

Conclusions: Refractory angina patients have reduced responsiveness in their cutaneous microcirculation to ACh, SNP and heat compared to healthy subjects. Although EECP reduced the CCS-class, this effect was not associated with improvements in responsiveness of the cutaneous microcirculation.

Keywords: enhanced external counterpulsation; flowmetry; microcirculation; refractory angina pectoris.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1.. Comparison of the mean difference…
Figure 1.. Comparison of the mean difference in angina measured by Canadian Cardiovascular Society (CCS) angina class after enhanced external counterpulsation (EECP) therapy and pharmacological treatment only (control) before and after EECP treatment/7 weeks. CCS-class I = Ordinary physical activity does not cause angina. CCS class-II = There is a slight limitation of ordinary activity. Angina may occur with walking more than two blocks, in the wind or under emotional stress. CCS class-III = There is a marked limitation of ordinary physical activity. Angina may occur after walking one block. CCS class-IV = There is inability to carry on any physical activity without discomfort; angina may be present at rest. All values are presented as mean ± SE. *P < 0.05.
Figure 2.. Microcirculatory responses to ACh (A)…
Figure 2.. Microcirculatory responses to ACh (A) and SNP (B) induced increase in cutaneous blood flow in the two refractory groups (EECP and control) and in healthy control. Figure 2C indicates percent change of microcirculatory response to local heating (+44°C) in the refractory group (EECP and control) and in the healthy control. All values are presented as mean ± SE. *P < 0.05, NS = not significant. ACh: acetylcholine; SNP: sodium nitroprusside; EECP: enhanced external counterpulsation.

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