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Coronary collateral growth by external counterpulsation: a randomised controlled trial
  1. Steffen Gloekler,
  2. Pascal Meier,
  3. Stefano F de Marchi,
  4. Tobias Rutz,
  5. Tobias Traupe,
  6. Stefano F Rimoldi,
  7. Kerstin Wustmann,
  8. Hélène Steck,
  9. Stéphane Cook,
  10. Rolf Vogel,
  11. Mario Togni,
  12. Christian Seiler
  1. Department of Cardiology, University Hospital, Bern, Switzerland
  1. Correspondence to Professor Christian Seiler, University Hospital, CH-3010 Bern, Switzerland; christian.seiler{at}


Background The efficacy of external counterpulsation (ECP) on coronary collateral growth has not been investigated in a randomised controlled study.

Objective To test the hypothesis that ECP augments collateral function during a 1 min coronary balloon occlusion.

Patients and methods Twenty patients with chronic stable coronary artery disease were studied. Before and after 30 h of randomly allocated ECP (20 90 min sessions over 4 weeks at 300 mm Hg inflation pressure) or sham ECP (same setting at 80 mm Hg inflation pressure), the invasive collateral flow index (CFI, no unit) was obtained in 34 vessels without coronary intervention. CFI was determined by the ratio of mean distal coronary occlusive pressure to mean aortic pressure with central venous pressure subtracted from both. Additionally, coronary collateral conductance (occlusive myocardial blood flow per aorto-coronary pressure drop) was determined by myocardial contrast echocardiography, and brachial artery flow-mediated dilatation was obtained.

Results CFI changed from 0.125 (0.073; interquartile range) at baseline to 0.174 (0.104) at follow-up in the ECP group (p=0.006), and from 0.129 (0.122) to 0.111 (0.125) in the sham ECP group (p=0.14). Baseline to follow-up change of coronary collateral conductance was from 0.365 (0.268) to 0.568 (0.585) ml/min/100 mm Hg in the ECP group (p=0.072), and from 0.229 (0.212) to 0.305 (0.422) ml/min/100 mm Hg in the sham ECP group (p=0.45). There was a correlation between the flow-mediated dilatation change from baseline to follow-up and the corresponding CFI change (r=0.584, p=0.027).

Conclusions ECP appears to be effective in promoting coronary collateral growth. The extent of collateral function improvement is related to the amount of improvement in the systemic endothelial function.

  • Arteriogenesis
  • coronary circulation
  • collateral circulation
  • external counterpulsation
  • fluid shear stress
  • echocardiography-contrast
  • coronary physiology
  • coronary collateral circulation
  • coronary haemodynamics
  • coronary artery disease

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  • Funding Swiss National Science Foundation for Research, Bern, Switzerland.

  • Competing interests None.

  • Ethical approval This study was conducted with the approval of the Kantonale Ethikkommission Bern, Switzerland.

  • Provenance and peer review Not commissioned; externally peer reviewed.