Exploring Functional And Symptomatic Improvements By Sex After Enhanced External Counterpulsation Therapy

Enhanced external counterpulsation (EECP) therapy is used for treating patients who do not qualify for interventional revascularization and still have ongoing refractory angina pectoris even with optimal medical therapies. EECP is a non-invasive outpatient-based treatment consisting of 35, one-hour sessions, utilizing ECG-triggered sequential compression of the lower limbs at rest using pneumatic cuffs. Previous research has demonstrated the safety and effectiveness of EECP therapy however, no study has explored the functional outcomes comparisons between sex. Purpose: To explore sex differences in functional capacity changes for patients with refractory angina pectoris after EECP. Methods: Utilizing the electronic medical record all patients who completed EECP between 2015 and 2023 at Winchester Medical Center, Winchester, VA were identified for analysis. Baseline and post-intervention six-minute walk tests (6MWT), exertional angina, and dyspnea measurements were assessed on the day of the first and last EECP session, respectively. Paired t tests were used to evaluate the effectiveness of EECP. Unpair t tests were used to compare differences in changes in outcome variables between the sexes. Logistic regression, and stepwise multivariate regression analysis were performed to identify predictors for improvements of 6MWT. Results: The cohort consisted of 116 patients (24 female) with an age of 69 ± 13 years (range 36-89). After EECP, there was an improvement of 128 ± 88 m (72%) in distance walked during the 6MWT (p < .05) with 126 ± 91 m improvement in males and 134 ± 73 m in females. The improvement in angina and dyspnea scores were 3.9 ± 2.4 and 4.2 ± 2.1, respectively (all p < .05). There were no differences between the sexes for improvements in 6MWT, angina or dyspnea. Univariate correlates for change in 6MWT distance included BMI (adjusted R2 = .05; p < .05) and being a non-smoker (adjusted R2 = .03; p < .05). The only independent predictor for increasing distance during 6MWT was BMI (adjusted R2 = .1; p < .05). Conclusion: EECP therapy effectively improves functional capacity while reducing exertional angina and dyspnea in male and female patients with chronic refractory angina pectoris. This study highlights the equal efficacy of EECP therapy for females, emphasizing its potential in future treatment options.