增強後的體外反搏可以改善心臟衰竭病患的心輸出量


  March 15, 2005(奧蘭多)-一項於美國心臟學會2005年會科學座談中發表的前瞻性評估EECP使用於鬱血性心臟衰竭(PEECH)的試驗結果顯示,增強後的體外反博(EECP),相較於僅使用最佳藥物治療的心臟衰竭病患,可以改善症狀、運動時間與生活品質。
  
  於會議中報告這項試驗結果的Arthur Feldman醫師,同時也是賓州費城Thomas Jefferson大學Jefferson醫學院內科部主任,他表示,EECP是一種包含放置一系列可以充氣的束帶,充氣後可以使大腿上方與下方分離;在心臟舒張與收縮時,束帶在高壓下快速地充氣及洩氣;根據Feldman醫師表示,這個方法是為了要模擬心臟主動脈內反博的血行動力學特性;他指出,試驗結果已經證實EECP可以改善穩定性心絞痛與心臟衰竭病患的心臟輸出量及內皮功能。
  
  為了確定EECP是否可以改善運動表現、症狀以及生活品質,PEECH研究者隨機分派187位輕度到中度心臟衰竭病患(紐約心臟組織〔NYHA〕分級II至III)接受EECP加上最佳藥物治療、或是僅接受最佳的藥物治療,為期7週;病患在接受治療結束後繼續追蹤6個月;所有病患皆接受貝它受體阻斷劑、以及血管張力素受體阻斷劑、或是血管張力素轉化酵素抑制劑;EECP於7週的療程中接受35次每次1小時的治療。
  
  主要試驗終點為有反應病患的比例,以治療前到治療6個月後的運動時間至少增加60秒以上,或是從治療前到治療6個月後尖峰VO2上升1.25 mL/min/kg以上來定義。
  
  Feldman醫師表示,EECP的耐受性良好;治療6個月後,35%接受EECP病患,以及25%的控制組病患的運動時間至少增加60秒以上,且達到統計上差異(P=.016);從治療前到治療6個月後,EECP組的運動時間已經增加25秒以上,然而控制組僅增加10秒;Feldman醫師表示,31% EECP組病患的NYHA分級改善,相較於控制組的16%,而且接受EECP病患的生活品質也獲得改善;然而,Feldman醫師表示,兩組治療組之間的尖峰VO2並沒有統計上的差異。
  
  根據Feldman醫師表示,PEECH試驗的結果顯示,至少接受6個月的EECP加上最佳的藥物治療可以改善運動時間;他與其同事表示,這項療法是接受最佳藥物治療的穩定性心臟衰竭病患的另一個選擇。
  
  於PEECH試驗發表會中擔任引言人的Christopher O'Connor醫師表示,EECP於心臟衰竭的治療上可以提供另一種選擇;但可能需要更多的臨床試驗來確定該療法於臨床照護中的角色。

Enhanced External Counterpulsa

By Martha Kerr
Medscape Medical News

March 15, 2005 (Orlando) — Results of the Prospective Evaluation of EECP in Congestive Heart Failure (PEECH) trial, announced here during the American College of Cardiology 2005 Annual Scientific Session, show that enhanced external counterpulsation (EECP) improves symptom status, exercise time, and quality of life compared with optimal pharmacologic treatment alone in patients with heart failure. 

Reporting the study results at the meeting, Arthur Feldman, MD, chairman of the department of medicine at Jefferson Medical College of Thomas Jefferson University in Philadelphia, Pennsylvania, explained that EECP is a technique that consists of placing a series of inflatable cuffs over the calves and lower and upper thighs. The cuffs rapidly inflate and deflate under high pressure at the onset of diastole and systole, respectively. According to Dr. Feldman, the approach is meant to mimic the hemodynamic properties of the heart's intra-aortic counterpulsation. He said that studies have shown that EECP improves cardiac output and endothelial function in patients with stable angina and in those with heart failure.

To determine whether EECP would improve exercise performance, symptom status, and quality of life, PEECH trial investigators randomized 187 patients with mild to moderate heart failure (New York Heart Association [NYHA] class II-III) to EECP plus optimal medical therapy or optimal medical therapy alone for seven weeks. Patients were followed for another six months. All patients received beta-blockers and either an angiotensin receptor blocker or an angiotensin-converting enzyme inhibitor. EECP was administered as 35 one-hour sessions over the course of seven weeks.

The primary end point was the percentage of patients who responded to therapy, defined as at least a minimum 60-second increase in exercise time from baseline to six months or at least a 1.25 mL/min/kg increase in peak VO2 from baseline to six months.

EECP was well-tolerated, Dr. Feldman said. After six months, 35% of EECP patients and 25% of control patients increased their exercise duration by at least 60 seconds, a difference that was statistically significant at P = .016. From baseline to six months, exercise time had increased 25 seconds in the EECP group, whereas it decreased 10 seconds in the control group. Dr. Feldman also reported that NYHA functional class improved 31% compared with 16% in the control group and that EECP patients reported a greater improvement in quality of life. However, there was no significant difference in peak VO2 between the two study groups, Dr. Feldman noted.

The results of the PEECH trial, according to Dr. Feldman, demonstrate that "the addition of a standard regimen of EECP to optimal pharmacologic therapy improves exercise time for at least six months." He and his colleagues suggest that the therapy is a suitable adjunct in patients with stable heart failure receiving optimal medical therapy.

Christopher O'Connor, MD, who moderated the panel during which the PEECH results were announced, commented that "[EECP] could provide another option" in the treatment of heart failure. Further trials may be warranted to determine the therapy's exact role in clinical care.

ACC 2005 Annual Scientific Session: Abstract  413-21. Presented March 8, 2008.

Reviewed by Gary D. Vogin, MD

    
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