Clinical effects of enhanced external counterpulsation treatment in patients with ischemic heart failure

Abstract

Objective: Enhanced external counterpulsation (EECP) is a noninvasive treatment that is proven safe and effective in patients with coronary artery disease (CAD) and heart failure (HF). The aims of this study are to investigate the clinical effects of EECP therapy in patients with symptomatic CAD and chronic HF, and to find out an answer to the question: Does EECP therapy have any effect on the prognostic markers of HF? Methods: This study was designed as a prospective cohort study. A total of 68 consecutive patients with symptomatic CAD and chronic HF referred to EECP therapy were enrolled in this study between November 2007 and December 2010; 47 patients (39 males and 8 females, 65±7, years), have undergone EECP treatment, and 21 patients (20 males and 1 female, 62±10 years), who did not want to participate in the EECP program comprised the control group. Statistical analysis was performed using t tests for dependent and independent samples, Mann-Whitney U test, Chi-square and Fischer exact tests. Results: EECP therapy resulted in significant improvement in post-intervention New York Heart Association functional class (p<0.001), left ventricular ejection fraction (p<0.001), B-type natriuretic peptide levels (p<0.003), uric acid levels (p<0.05), free-T3/free-T4 ratio (p<0.034) and mitral annular E (p<0.05) velocity, compared with baseline, a finding not evident in the control group. Conclusion: EECP treatment significantly improved clinical and some biochemical parameters, which are mostly prognostic markers in patients with symptomatic CAD and chronic HF. (Anadolu Kardiyol Derg 2012; 12: 214-21)

Enhanced external counterpulsation improves endothelial function and exercise capacity in patients with ischaemic left ventricular dysfunction

“…Based on their findings, Kozdag and colleagues concluded that EECP treatment improves clinical and biochemical parameters which are prognostic markers in symptomatic CAD patients with LVD. (16) In the current study, we report similar reductions in functional classification after EECP in CAD patients with or without LVD.…”

“…However, in the present study LVEF in the LVD groups were similar at baseline to those investigated by Kozdag and colleagues and we can only conclude that the patients in the current study responded similar to those in the previous study. (16) Major limitations of the present study are the small sample size and the absence of a control or Sham EECP group. Therefore, the possibility of a training effect or over estimation of the treatment effect cannot be entirely excluded.…”

“…(16) They report significant improvements in New York Heart Association (NYHA) functional classification, left ventricular ejection fraction, B-natriurietic peptide and uric acid levels, free-T3/free-T4 ratio, and mitral annular E velocity. (16) During EECP therapy, cuff inflation leads to aortic diastolic pressure augmentation, resulting in increased diastolic coronary pressure and increased coronary blood flow; whereas cuff deflation results in left ventricular systolic unloading. (17) Ultimately, this pattern of pneumatic cuff inflation and deflation acutely elicits a decrease in systemic vascular resistance and afterload resulting in an increase in cardiac output.…”

“…(16) Further, a ~4% improvement in LVEF is associated with a 47% increase in maximal aerobic capacity in patients with HF. (23) Indeed, in the present study EECP therapy increased maximal aerobic capacity, exercise duration, and time to anginal symptoms during exercise while reducing overall self perceived anginal rating at maximal exertion (Table 3).…”

The Role of Enhanced External Counter Pulsation Therapy in Clinical Practice

“…23 EECP therapy has been shown to significantly increase LVEF and significantly reduce resting heart rate. 24 EECP therapy has also been shown to be of benefit for patients with ischemic and non-ischemic cardiomyopathy, systolic or diastolic dysfunction.…”