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Benefits in heart failure patients have been noted, but <jats:styled-content style=\"fixed-case\">EECP<\/jats:styled-content> is still considered to be experimental and its effects must be confirmed. The mechanism of action is still unclear. The aim of this study was to evaluate the effect of <jats:styled-content style=\"fixed-case\">EECP<\/jats:styled-content> on skeletal muscle gene expression and physical performance in patients with severe heart failure. Patients (<jats:italic>n\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>9) in <jats:styled-content style=\"fixed-case\">NYHA III<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> despite pharmacological therapy were subjected to 35\u00a0h of <jats:styled-content style=\"fixed-case\">EECP<\/jats:styled-content> during 7\u00a0weeks. Before and after, lateral vastus muscle biopsies were obtained, and functional capacity was evaluated with a 6\u2010min walk test. Skeletal muscle gene expression was evaluated using Affymetrix Hugene 1.0 arrays. Maximum walking distance increased by 15%, which is in parity to that achieved after aerobic exercise training in similar patients. Skeletal muscle gene expression analysis using Ingenuity Pathway Analysis showed an increased expression of two networks of genes with <jats:styled-content style=\"fixed-case\">FGF<\/jats:styled-content>\u20102 and <jats:styled-content style=\"fixed-case\">IGF<\/jats:styled-content>\u20101 as central regulators. The increase in gene expression was quantitatively small and no overlap with gene expression profiles after exercise training could be detected despite adequate statistical power. <jats:styled-content style=\"fixed-case\">EECP<\/jats:styled-content> treatment leads to a robust improvement in walking distance in patients with severe heart failure and does induce a skeletal muscle transcriptional response, but this response is small and with no significant overlap with the transcriptional signature seen after exercise training.<\/jats:p>","DOI":"10.1111\/cpf.12392","type":"journal-article","created":{"date-parts":[[2016,10,26]],"date-time":"2016-10-26T09:08:40Z","timestamp":1477472920000},"page":"118-127","source":"Crossref","is-referenced-by-count":7,"title":["Effects of enhanced external counterpulsation on skeletal muscle gene expression in patients with severe heart 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