14th Vietnam National Congress of Cardiology Da Nang, Vietnam October 11-14, 2014 Managing Angina and Risk via Improved Endothelial Function: The EECP Model Gregory W Barsness, MD, FACC, FAHA, FSCAI Consultant, Internal Medicine & Cardiology and Radiology Director, Mayo Clinic EECP Laboratory Director, Mayo Clinic Cardiac Intensive Care Unit Mayo Clinic College of Medicine Rochester, MN, USA Nothing to Disclose Related to this Talk Endothelial Function The Importance of Balance Normal Endothelial Function NO ET-1 PGI2 AngII Vasodilation Atheroprotective NO Function Vasodilatory Antithrombotic Antiproliferative Anti-inflammatory Endothelial Function The Importance of Balance Endothelial Dysfunction NO PGI2 ET-1 AngII ↓Endothelial repair Depletion of EPCs Vasoconstriction Atherogenic Coronary Endothelial Dysfunction Relationship to Risk Factors 15 10 Slope of Ach dose response -5 relationship (% diameter -10 change/log -15 Ach) -20 -25 -30 r=-0.73 P[...]... Inhibitors/ARBs Calcium Channel Blockers N-3 Fatty Acids Glycemic Control in Diabetes Blood Pressure Lowering Smoking Cessation Weight Reduction Exercise PDE-5 Inhibitors Aspirin EECP The Bottom Line  Optimal medical therapy and risk factor modification are essential to improve endothelial function and outcome  Exercise and EECP provide safe, effective, durable symptom relief:  Improved QoL and vascular