Prior revascularization increases the effectiveness of enhanced external counterpulsation

Abstract

SummaryBtrckground and hypothesis: Enhanced external counterpulsation (EECP) is an effective noninvasive treatment for chronic angina. However, its usefulness has been felt to be limited in patients with angiographically demonstrated triplevessel coronary artery disease (CAD), in accord with the hypothesis that a patent vessel is necessary for transmission of the EECP-augmented coronary artery pressure and volume to the distal coronary vasculature.Md?ods: The effect of revascularization [coronary artery bypass grafting (CABG)] prior to EECP was examined in 60 patients with CAD and chronic angina (35 without and 25 with prior CABG). Patients were grouped by the extent of CAD (single-, double-, triple-vessel disease in the unrevascularized group) and by the extent ofresidual disease (number of stenotic native vessels unbypassed or supplied by a stenotic graft in the CABG group). Significant CAD or graft stenoses were defined as stenoses demonstrating 2 70% luminal diameter narrowing. Benefit was assessed by improvement in post-EECP treatment over pretreatment radionuclide stress testing.Krnrlrs: Radionuclide stress testing demonstrated a comparable favorable response (80 vs. 7 1 %: p = NS) in patients with prior CABG versus unrevascularized patients. Enhanced external counterpulsation was highly and comparably effective in patients with unrevascularized native single-and double-vessel CAD and in patients with CABG with residual sin- Conclusion:The results suggest a new role for EECP as an effective treatment for post CABG ischemia, despite extensive CAD and even in the presence of stenotic grafts.

Angiogenic effects of long-term enhanced external counterpulsation in a dog model of myocardial infarction

“…A randomized clinical trial demonstrated significant improvement in the time to ST-segment depression during treadmill stress tests in the EECPtreated group compared with the control group (1). Several case study series and the International EECP Patient Registry, with more than 5,000 patients, have confirmed the benefits of EECP in providing symptomatic relief of angina (2, 7), improving blood flow to ischemic areas of myocardium [by radionuclide stress testing (6,12) and positron emission tomography (PET) scans (11)], eliminating or reducing nitrate use (10), as well as improving exercise tolerance (1,8). These effects have been reported to be sustained over several years (5,9).…”

The role of enhanced external counterpulsation in the treatment of angina and heart failure

“…Its use has been documented for more than four decades, but its use in the treatment of heart failure is incipient. Numerous small clinical studies of patients with stable chronic angina pectoris have shown improved cardiac perfusion imaging (2,(8)(9)(10)(11)(12)(13), reduction of angina class (2,9,10,12,13), increases in exercise tolerance (2,(8)(9)(10)(11), decreased use of nitroglycerine (10,12,13) and increased time to ST segment depression on stress testing with the use of EECP (2,8). Some of these studies have shown a sustained improvement for as long as five years after treatment (13).…”

Current use of enhanced external counterpulsation and patient selection

“…8 The premise was that patients with more conduits tended to respond better than those who did not have these extra conduits. Patients with more extensive disease, such as those with triple-vessel disease, did not do quite as well as those with single-and doublevessel disease (Fig.…”