The effect of external counterpulsation on vascular endothelial growth factor receptor-2 preservation in enhancing 6 minutes-walking-test in coronary artery disease with stable chronic heart failure

Background External counterpulsation (ECP) is a non-invasive treatment that has been explored for its potential in managing coronary artery disease (CAD) and heart failure. The currently understood process involves an alteration of endothelial function in the coronary vascular bed. Insufficient levels of angiogenic factors, specifically Vascular Endothelial Growth Factor (VEGF), in cardiac hypertrophy, will hinder the process of cardiac vascularization and damage its function. Purpose This study aimed to unveil the effect of ECP intervention on angiogenesis processes and its clinical implication in heart failure. Methods This randomized sham-controlled trial enrolled 38 CAD patients with Heart Failure with Reduced Ejection Fraction (HFrEF) and Heart Failure with Preserved Ejection Fraction (HFpEF). The participants were patients between 45 to 78 years old, randomly divided into ECP treatment (n=21) and sham (n=17), and underwent 35 sessions of ECP which each lasting for 1 hour. History taking, physical and examination was conducted at the beginning, also 6 minutes-walking-test (6 MWT) and blood samples were collected both before the first treatment and after the completion of all sessions. Wilcoxon and independent T-test analysis were conducted to analyze the influence of ECP towards VEGF receptor-2 (VEGFR-2) and 6 MWT. Result ECP treatment in patients with heart failure and coronary artery disease (CAD) successfully inhibits the deterioration of VEGFR-2 [D VEGFR-2 sham: -497.52 (5,239.64 to 5,737.17), vs. ECP: -76.42 (4,919.05 to 4,995.52), p = 0.016), as compared to control patients. As a result, the ECP group shows increased levels of VEGFR-2, which enhances the process of angiogenesis. This promotes pro-angiogenic activity by preserving VEGFR-2 and ultimately improves tissue perfusion. The therapeutic significance of this improved blood flow is demonstrated by the better 6MWT scores [xˉ 6 MWT sham: 360.52 m vs.ECP: 371.33 m] observed in individuals who had ECP compared to the sham group. Conclusion ECP treatment resulted in an improvement of the clinical symptoms in patients with heart failure by promoting angiogenesis through the preservation the amount of VEGF receptors in the body.Baseline CharacteristicsFor image description, please refer to the figure legend and surrounding text. VEGFR2 Difference Between GroupsFor image description, please refer to the figure legend and surrounding text.