Enhanced External Counterpulsation for Management of Postacute Sequelae of SARS-CoV-2 Associated Microvascular Angina and Fatigue: An Interventional Pilot Study

Eline Wu; Ali Mahdi; Jannike Nickander; Judith Bruchfeld; Linda Mellbin; Kristina Haugaa; Marcus Ståhlberg; Liyew Desta

doi:10.1155/2023/6687803

Enhanced External Counterpulsation for Management of Postacute Sequelae of SARS-CoV-2 Associated Microvascular Angina and Fatigue: An Interventional Pilot Study

Cardiol Res Pract. 2023 Dec 27:2023:6687803. doi: 10.1155/2023/6687803. eCollection 2023.

Authors

Eline Wu^{1

2}, Ali Mahdi^{2

3}, Jannike Nickander⁴, Judith Bruchfeld^{5

6}, Linda Mellbin^{2

3}, Kristina Haugaa^{1

2}, Marcus Ståhlberg^{2

3}, Liyew Desta^{2

3}

Affiliations

¹ Division of Cardiology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
² Heart and Vascular Center, Karolinska University Hospital, Stockholm, Sweden.
³ Division of Cardiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
⁴ Department of Clinical Physiology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden.
⁵ Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
⁶ Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.

Abstract

Background: Postacute sequelae of SARS-CoV-2 infection (PASC) are a novel clinical syndrome characterized in part by endothelial dysfunction. Enhanced external counterpulsation (EECP) produces pulsatile shear stress, which has been associated with improvements in systemic endothelial function.

Objective: To explore the effects of EECP on symptom burden, physical capacity, mental health, and health-related quality of life (HRQoL) in patients with PASC-associated angina and microvascular dysfunction (MVD).

Methods: An interventional pilot study was performed, including 10 patients (male = 5, mean age 50.3 years) recruited from a tertiary specialized PASC clinic. Patients with angina and MVD, defined as index of microcirculatory resistance (IMR) ≥25 and/or diagnosed through stress perfusion cardiac magnetic resonance imaging, were included. Patients underwent one modified EECP course (15 one-hour sessions over five weeks). Symptom burden, six-minute walk test, and validated generic self-reported instruments for measuring psychological distress and HRQoL were assessed before and one month after treatment.

Results: At baseline, most commonly reported PASC symptoms were angina (100%), fatigue (80%), and dyspnea (80%). Other symptoms included palpitations (50%), concentration impairment (50%), muscle pain (30%), and brain fog (30%). Mean IMR was 63.6. After EECP, 6MWD increased (mean 29.5 m, median 21 m) and angina and fatigue improved. Mean depression scores showed reduced symptoms (-0.8). Mean HRQoL scores improved in seven out of eight subscales (+0.2 to 10.5).

Conclusions: Patients with PASC-associated angina and evidence of MVD experienced subjective and objective benefits from EECP. The treatment was well-tolerated. These findings warrant controlled studies in a larger cohort.