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ECP therapy produces beneficial effects that appear mediated through arterial diastolic augmentation. Continuation of benefits for up to 3 years following a course of ECP treatment has been reported. The retrograde arterial pressure wave increases coronary perfusion pressure, creating a gradient between ischemic and non-ischemic areas of the myocardium that may recruit latent conduits and enhance myocardial perfusion.

Diastolic augmentation produced by ECP greatly increases pulsatile shear stress on the intima. Recent research has uncovered a multitude of endothelial responses to shear stress. Increased endothelial shear stress releases growth factors. Increased nitric oxide (NO) and atrial natriuretic peptide (ANP) levels, and decreased endothelin (EN-1) and brain natriuretic peptide (BNP) levels, also ascribed to increased shear stress and improved endothelial function, raise the possibility of peripheral benefits as well as restored coronary flow reserve.

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