Course Of Enhanced External Counterpulsation Research Articles

Enhanced External Counterpulsation for Management of Postacute Sequelae of SARS-CoV-2 Associated Microvascular Angina and Fatigue: An Interventional Pilot Study.

Postacute sequelae of SARS-CoV-2 infection (PASC) are a novel clinical syndrome characterized in part by endothelial dysfunction. Enhanced external counterpulsation (EECP) produces pulsatile shear stress, which has been associated with improvements in systemic endothelial function. To explore the effects of EECP on symptom burden, physical capacity, mental health, and health-related quality of life (HRQoL) in patients with PASC-associated angina and microvascular dysfunction (MVD). An interventional pilot study was performed, including 10 patients (male = 5, mean age 50.3 years) recruited from a tertiary specialized PASC clinic. Patients with angina and MVD, defined as index of microcirculatory resistance (IMR) ≥25 and/or diagnosed through stress perfusion cardiac magnetic resonance imaging, were included. Patients underwent one modified EECP course (15 one-hour sessions over five weeks). Symptom burden, six-minute walk test, and validated generic self-reported instruments for measuring psychological distress and HRQoL were assessed before and one month after treatment. At baseline, most commonly reported PASC symptoms were angina (100%), fatigue (80%), and dyspnea (80%). Other symptoms included palpitations (50%), concentration impairment (50%), muscle pain (30%), and brain fog (30%). Mean IMR was 63.6. After EECP, 6MWD increased (mean 29.5 m, median 21 m) and angina and fatigue improved. Mean depression scores showed reduced symptoms (-0.8). Mean HRQoL scores improved in seven out of eight subscales (+0.2 to 10.5). Patients with PASC-associated angina and evidence of MVD experienced subjective and objective benefits from EECP. The treatment was well-tolerated. These findings warrant controlled studies in a larger cohort.

Predictors of adherence of enhanced external counterpulsation in patients with coronary heart disease after discharge: A mixed-methods study.

Although enhanced external counter pulsation (EECP) has been included in the cardiac rehabilitation prescription for coronary heart disease (CHD) in China, because the total treatment duration of a course of EECP is 36-36 h, the average hospital stay of CHD patients is short, and the adherence after discharge remains unclear. The purpose of this study is to investigate the adherence to EECP in CHD patients after discharge, and analyze the related influencing factors. A retrospective mixed method study combining qualitative and quantitative methods. Quantitative component included CHD patients who had received EECP treatment between March 2020 and August 2021. The qualitative component included in-depth interviews with patients who did not adhere to EECP after discharge. Binary Logistic regression was used to analyze the predictors of EECP adherence after discharge. In-depth interviews with patients were conducted to explore the reasons for dropping out of the EECP after discharge. Among 1,304 patients, only 24.23% adhered to EECP treatment after discharge. Binary logistic regression results showed that patients with disease duration < 2 years (OR = 3.13, 95%CI: 2.31-4.24), high school or below (OR = 2.81, 95%CI: 1.98-4.01), distance between residence and hospital more than 20km (OR = 2.08, 95%CI: 1.47-2.96), age over 60 (OR = 2.00, 95%CI: 1.46-2.74), female (OR = 1.64, 95%CI: 1.78-2.29), and angina pectoris (OR = 1.65, 95%CI: 1.16-2.34) were more likely to not adhere to EECP treatment after discharge. However, patients with monthly family income over 8000¥ (OR = 0.46, 95%CI: 0.28-0.75) were more likely to adhere to EECP treatment after discharge than those with household monthly income below 4,000¥. In the qualitative results, the reasons why patients do not adhere to EECP after discharge mainly include insufficient understanding, restricted objective conditions and psychosocial factors. The adherence of CHD patients to EECP treatment after discharge was poor. It is necessary to develop effective intervention measures, such as brochures or videos to improve patients' understanding of the importance of adherence to EECP treatment after discharge. In addition, offering EECP treatment during off-hours and weekends may also improve adherence in more young patients.

The Effect of Enhanced External Counterpulsation on the Vascular State, Indicators of Glycemic Control and Quality of Life in Patients with Coronary Artery Disease and Type 2 Diabetes Mellitus

Aim. To study the effect of enhanced external counterpulsation (EECP) on the functional status, quality of life, structural and functional state of the vascular bed, and markers of glycemic control in patients with coronary artery disease (CAD) and type 2 diabetes mellitus (DM).Material and methods. A pilot prospective randomized study included 30 patients with CAD and DM. Using a random number generator, patients were randomized into 2 groups: EECP (n=15) and a comparison group (n=15). All patients (n=30) received optimal medical therapy (OMT) during 3 months of follow-up. Patients in the EECP group underwent a course of EECP (35 hours, cuff pressure: 220-280 mmHg) during the first 7 weeks of the study. At baseline and after 3 months of follow-up, patients in both groups underwent an assessment of clinical status, quality of life (based on the SF-36 questionnaire), as well as a 6-minute walk test to assess exercise tolerance. The dynamics of fasting glucose, postprandial glucose, insulin resistance index (HOMA-IR) and glycated hemoglobin were assessed. Photoplethysmography and applanation tonometry were performed to assess the state of the vascular bed.Results. In the EECP group, after 3 months, there was a decrease in the frequency of angina attacks and an improvement in the functional class of angina according to the Canadian Cardiovascular Society (CCS) classification. A significant improvement in exercise tolerance was revealed [an increase in the 6-minute walking distance by 51 (35; 65) m, p&lt;0.05], as well as an improvement in the physical and mental components of health according to the SF-36 questionnaire. A positive dynamics was shown in relation to the indicators of the state of both large vessels and the microvasculature (p&gt;0.05), with the exception of the reflection index and the stiffness index (p&lt;0.05). There was also a significant decrease in the HOMA-IR [-9.9% (-26.5; -4.0) vs 7.7% (-7.9; 13.8), p=0.004], as well as in the levels of fasting glucose [-10.5% (-15.8; -4.0) vs -2.7 (-8.3; 5.9), p=0.012] in the EECP group, compared with the OMT group.Conclusion. EECP course therapy in addition to OMT has a positive effect on the functional status and quality of life of patients with CAD and DM. After 3 months of observation, there was noted a positive dynamics of the vascular state, as well as markers of glycemic control, and these changes were more pronounced in the EECP group. The results obtained may indicate the effectiveness of EECP as an add-on treatment for this group of patients.

Efficacy of enhanced external counter pulsation in improving six minutes’ walk test in heart failure patients

Introduction and Aim: Enhanced External Counterpulsation (EECP) is an outpatient treatment to improve myocardial perfusion in chronic stable angina patients. We studied the clinical response of heart failure patients' improvement in the functional class and exercise tolerance with EECP. Materials and Methods: We prospectively evaluated twenty-six patients, who had completed a course of EECP with pre and post six minutes’ walk test, functional ability assessed by the New York heart association (NYHA) classification, renal parameters, lipid profile, and diastole to systole(d/s) ratio in terms of Peak amplitude (P) and Area (A) under the curve value. Results: The study group's mean age is of 56 years. The mean left ventricular ejection fraction (LVEF) is 31.44± 5.5%. Patients' demography includes 81% were male, 30% with hypertension (HT),50% with diabetes mellitus (DM), 30%chronic smokers, 61% of them had triple vessel disease (TVD). All the patients improved by a minimum of one NYHA class improvement, Serum urea reduced from 34.37 ± 20.28 to 27.24 ± 18.73 mg/dL (P = 0.002), C-Reactive protein (CRP) reduced from 4.6± 8.0 to 3.76 ± 5.1 mg/dL (P = 0.62). In the measured lipid panel test, only low-density lipoprotein (LDL) reduction from 94.41 ± 38.66 to 80.51 ± 35.09 mg/dL was statistically significant (P =0.03). The six-minute walk test, post-EECP, improved significantly from 340.14 ± 68.5 to 385.5 ± 73.9 meters (P =0.0004). The LVEF increased from 31.44 ± 5.5 to 38.38 ± 8.69 % (P=0.001). Conclusion: EECP treatment significantly improves shortness of breath, six minutes walking distance, and ejection fraction in heart failure patients. The treatment significantly reduces serum urea and LDL level. These positive changes may be due to a sudden increase in cardiac output and hyperdynamic circulation during the treatment.

Application of enhanced external counterpulsation in treating patients with stable ischemic heart disease

Abstract Introduction Currently, enhanced external counterpulsation (EECP) is one of the safest non-invasive treatments for patients with coronary artery disease (CAD). In combination with traditional drug therapy, EECP can significantly improve the quality of life of patients by increasing coronary perfusion, improving myocardial contractile function, and improving endothelial function. Aim To study the effect of EECP on clinical status, quality of life (QL) and structural-functional state of blood vessels in patients with stable coronary artery disease. Materials and methods In the present study 67 CAD patients were included (average age 65.7±5.66 years; men 71.9%, angina pectoris of functional class II-III (FC)). All patients were on optimal medical therapy (ACE inhibitors, beta-blockers, antiplatelet agents, statins, nitrates), which remained unchanged during the follow-up. Patients were given a course of EECP (35 procedures 220–280 mmHg.art.). Test 6-minute walk (T6MW), QL (Minnesota Satisfaction Questionnaire (MSQ)), echocardiography (ejection fraction of the left ventricle (LVEF)) were performed at baseline and after 6 months. In addition, all the patients underwent laser photoplethysmography (Stiffness index (SI, m/s), phase shift (PS m/s) occlusion index (OI), nail fold videocapillaroscopy (capillary density at rest, after reactive hyperemia and venous occlusion (CDr, CDrh, CDvo, respectively, cap/mm2) and applanation tonometry (central aortic systolic pressure (CASP), (radial augmentation index (RAI)) in order to assess structural and functional characteristics of blood vessels. Results In six months after EECP, significant improvement in patient's condition was found. T6MW distance (212±32 vs 251±29 m, p&amp;lt;0.05), QL MSQ (20.1±6.2 vs 41,6±7,1, p&amp;lt;0.05) and LVEF (40.9±7,6% vs 45.2±10.1%, p&amp;lt;0.05) increased significantly. Stiffness of large vessels was found to be decreased. CASP, RAI and SI decreased significantly, (CASP: 131±15.8 vs 129±14.8 mmHg, p&amp;lt;0.05), (RAI: 97.2±25.1 vs 97±21.6%, p&amp;lt;0.05), (SI: 8.9±1.5 vs 8.8±,1.6 m/s, p&amp;lt;0.05), Functional characteristics of large blood vessels significantly improved (PS (5.6±1.2 vs 6.8±1.4 m/s, p&amp;lt;0.05). Microcirculation - Reflection index (106.7 vs 95.3%, p&amp;lt;0.05) and OI (1.5±0.3 vs 1.66±0.26, p&amp;lt;0.05) for all. Increase CDrest (44±12.2–44.6±11.5 capillaries, p&amp;gt;0.05), in samples with CDrh (45±14 vs 57±16 capillaries, p&amp;lt;0.05) and CDvo (55±15–56 vs 4±14.2 capillaries, p&amp;lt;0.05). Conclusion ECCP treatment of patients with stable CAD, in addition to optimal drug therapy, led to an increase in load tolerance and improvement of the QL, myocardial contractile function, accompanied by improvement of the structural and functional state of large vessels and microcirculatory bed. Funding Acknowledgement Type of funding sources: None.

Clinical effects of the enhanced external counterpulsation therapy in patients with ischemic chronic heart failure exacerbation COVID-19

Abstract Objectives The aim of the study was to assess the effects of the enhanced external counterpulsation (EECP) therapy as a rehabilitation method in patients with ischemic chronic heart failure (CHF) after COVID-19. Methods 54 (n=54) stable symptomatic CHF (NYHA, functional class I-II; 35%≤LVEF≤50%) subjects (44 male and 10 female; mean age 61±9,8) with prior anamnesis of CAD, at least one myocardial infarction got the exacerbation of CHF after COVID-19 episode. They were randomized in a 2:1 manner into either 35 1-hour 250–300 mm Hg sessions of EECP (n=36; 30 male, 6 female) or Sham-EECP (n=18; 14 male, 4 female). All subjects had been received optimal CHF and CAD drug therapy. At baseline, a month and half a year after EECP course every subject was examined with echocardiography and 6-minute walk test. Results All 36 active EECP treatment group subjects improved by at least 1 NYHA class, 66% of them had no heart failure symptoms post treatment (p&amp;lt;0.01). 84% of treatment group pts. had sustained NYHA class improvement at half a year follow-up (p&amp;lt;0.01), compared with baseline. There was significant difference between LVEF 44±6,5% at baseline vs post-EECP LVEF 50±4,6% (p&amp;lt;0.01) in active EECP treatment group subjects. At the same time there were no significant changes of NYHA class and LVEF in Sham-EECP subjects. No one subject dies after half a year of follow up. Conclusions Enhanced external counterpulsation (EECP) therapy sustainably improves NYHA functional class and LVEF in patients with ischemic CHF exacerbation after COVID-19. Funding Acknowledgement Type of funding sources: None.

Medium-term Effects of Enhanced External Counterpulsation in the Structural and Functional Parameters of Blood Vessels in Patients with Coronary Artery Disease

Aim. To study the mid-term effects of enhanced external counterpulsation (EECP) in the structural and functional parameters of blood vessels, exercise tolerance and quality of life indicators in patients with verified coronary artery disease (CAD).Material and methods. Patients (n=70) with verified stable CAD (angina pectoris class II-III) complicated by chronic heart faillure class II-III (NYHA) were included in the study. Data from 65 patients (48 to 74 years old; 45 men and 20 women) are included in the final analysis. All patients had a course of EECP (35 hours procedures with a compression pressure of 220-280 mm Hg). All patients at baseline, 3 and 6 months later had a 6 walk minute test (6WMT), an assessment of the clinical status, quality of life of patients (Minnesota Living with Heart Failure Questionnaire, SF-36). Computer nailfold video capillaroscopy, photoplethysmography with pulse wave recording and contour analysis, applanation tonometry to assess central aortic systolic pressure and radial augmentation index were performed to assess the structural and functional state of large and microcirculatory vessels.Results. Significant improvement in exercise tolerance both after 3 and after 6 months (increase in distance in 6WMT by 44.6% after 3 months and 34.3% after 6 months, p &lt;0.05), improved quality of life (increased overall score on the SF-36 questionnaire from 50.3±8.1 to 59.8±8.8, p&lt;0.05), an increase in the left ventricular ejection fraction were found. Significant improvement in indicators showing the function of the endothelium of both large vessels (phase shift: from 5.6 [2.45; 7.3] to 6.8 [3.1; 8.1] m / s) and microcirculatory vessels (occlusion index: from 1.51 [1.21; 1.7] to 1.66 [1.2; 1.9]), as well as a decrease in functional disorders of the capillary bed of the skin (% of perfused capillaries, density of the capillary network in the test with reactive hyperemia) were found after 3 months. However, after 6 months, there were no significant changes in these parameters compared to the baseline value. No significant change in indicators showing structural remodeling of both large vessels and microcirculatory vessels was found.Conclusion. The positive effect of the EECP course on the functional status (exercise tolerance) and quality of life in patients with stable coronary artery disease complicated by chronic heart faillure was found both after 3 and 6 months. Positive dynamics of the functional state of large vessels and microvasculature was found only after 3 months.

Abstract P100: Enhanced External Counterpulsation Reduces Central Blood Pressure In Stable Angina Patients: A Meta Analysis

Introduction: Emerging evidence suggests central systolic blood pressure (cSBP) and augmentation index are superior predictors of adverse cardiovascular outcomes as compared to peripheral systolic blood pressure (pSBP). Enhanced external counterpulsation (EECP) is a non-invasive treatment modality approved for the management of refractory angina. The degree of benefit from EECP on central hemodynamics and arterial stiffness remains unknown. This meta-analysis evaluated the effect of EECP on peripheral (office) blood pressure and central hemodynamic parameters. Methods: A comprehensive literature search was conducted in Pubmed, CINAHL, and Cochrane Library databases. All prospective clinical trials assessing the impact of EECP in patients with stable angina and CAD were included. Studies were excluded for not completing a full course of EECP, having a baseline peripheral systolic blood pressure &amp;lt100 mmHg, or not reporting adequate data for analysis. The primary endpoint was the change in cSBP before and after EECP. The change in pSBP, pDBP, cDBP, and augmentation index before and after EECP were also assessed. The weighted mean difference using the DerSimonian and Laird random-effect model was utilized for determining the change in each parameter before and after EECP. Statistical heterogeneity was evaluated using the Egger’s bias statistic. Results: Five studies containing 137 unique patients were included for the cSBP analysis. cSBP was reduced significantly by -7.56 mmHg (95% CI -11.83 to -3.28; Cochrane Q=1.81) post-EECP. In the same set of studies, pSBP was reduced significantly by -9.65 mmHg (95% CI -14.32 to -4.98) post-EECP. pDBP [-4.67 mmHg (95% CI -8.56 to -0.77)] was reduced post-EECP, while no changes were evident in cDBP. Augmentation index was reduced by -3.74% (95% CI -7.05 to -0.43) post-EECP. Two studies included a sham-EECP intervention arm and demonstrated no significant changes in cSBP [0.67 mmHg (95% CI -5.66 to 7.01)] or other parameters. Conclusion: EECP significantly reduced cSBP and pSBP by approximately 8 mmHg and 10 mmHg respectively. EECP also demonstrated a mild improvement in arterial stiffness, which translates to reduced wasted left ventricular energy and myocardial oxygen demand. In patients with stable angina and CAD, EECP exerts beneficial effects in both peripheral and central hemodynamics but whether these benefits are sustained over a longer duration need further exploration.

The Use of Enhanced External Counterpulsation in the Treatment of Patients with Coronary Artery Disease

Enhanced external counterpulsation (EECP) is one of the most effective and safe non-invasive methods of treatment for patients with coronary artery disease (CAD), including complicated chronic heart failure (CHF). This method of therapeutic neoangiogenesis, used in conjunction with traditional drug therapy and myocardial revascularization, can significantly improve the quality of management of these patients.Aim. To study the effect of the EECP course on exercise tolerance, quality of life, structural and functional parameters of blood vessels in patients with verified stable CAD complicated by CHF.Material and methods. Patients (n=70) with verified stable CAD (angina pectoris class II-III) complicated by CHF class II-III (NYHA) were included in non-randomized uncontrolled study. Data from 67 patients (48 to 74 years old; 47 men and 20 women) were included in the final analysis. All patients had a course of EECP (35 one-hour procedures with a compression pressure of 220-280 mm Hg). All patients initially and 1.5 months after the EECP course had a 6-minute walk test (6MWT), an assessment of the clinical status, quality of life of patients (MLHFQ; Minnesota Living with Heart Failure Questionnaire). Computer nailfold video capillaroscopy, photoplethysmography with pulse wave recording and contour analysis, applanation tonometry to assess central aortic systolic pressure and radial augmentation index (RAI) were performed to assess the structural and functional state of large and microcirculatory vessels.Results. A statistically significant improvement in exercise tolerance (increase in distance in 6MWT from 212 [189; 273] to 308 [251; 336] m), improvement in the clinical status of patients (decrease in points on the rating scale of clinical state from 6.5±1.8 to 4.4±1,2), improvement in the quality of life according to the MLHFQ questionnaire (from 51.9±6.2 to 38.6±7.1), increase in the left ventricle ejection fraction (from 41.6 [36.6;47.1] to 44.8 [39.5;50.7]%) were found. A statistically significant improvement in endothelial function indices of both large vessels (phase shift: from 5.6 [2.4;7.2] to 6.8 [3.3;8] m/s) and microcirculatory vessels (occlusion index: from 1.5 [1.2;1.7] to 1.66 [1.3;1.9]), as well as a decrease in functional disorders of nailfold capillaries (percent of perfused capillaries, capillary network density in the reactive hyperemia test) also were found. But no statistically significant changes in the structural remodeling indices of both large and microcirculatory vessels were found.Conclusion. A positive effect of the EECP course both on the functional status with an increase in exercise tolerance and improvement in the quality of life, and on the functional state of large vessels and microvasculature was found in patients with stable CAD complicated by CHF.

Effectiveness of Enhanced External Counterpulsation Treatment on Symptom Burden, Medication Profile, Physical Capacity, Cardiac Anxiety, and Health-Related Quality of Life in Patients With Refractory Angina Pectoris.

Patients with refractory angina pectoris experience recurrent symptoms that limit their functional capacity, including psychological distress and impaired health-related quality of life (HRQoL), despite optimized medical therapy. Enhanced external counterpulsation (EECP) is an evidence-based alternative noninvasive treatment. Although physical well-being and mental well-being are equally important components of health, few studies have investigated the psychological effects of EECP in patients with refractory angina pectoris. The aim of this study was to evaluate the effects of EECP treatment in patients with refractory angina pectoris regarding medication profile, physical capacity, cardiac anxiety, and HRQoL. This quasi-experimental study with 1-group pretest-posttest design includes a 6-month follow-up of 50 patients (men, n = 37; mean age, 65.8 years) who had undergone 1 EECP course. The following pretreatment and posttreatment data were collected: medication use, 6-minute walk test results, functional class according to the Canadian Cardiovascular Society, and self-reported (ie, questionnaire data) cardiac anxiety and HRQoL. In addition, the questionnaires were also completed at a 6-month follow-up. After EECP treatment, patients used significantly less nitrates (P < .001), walking distance increased on average by 46 m (P < .001), and Canadian Cardiovascular Society class improved (P < .001). In addition, all but 1 subscale of cardiac anxiety and all HRQoL components improved significantly (P < .05). The positive effects for cardiac anxiety and HRQoL were maintained at the 6-month follow-up. Enhanced external counterpulsation treatment resulted in reduced symptom burden, improved physical capacity, and less cardiac anxiety, leading to increased physical activity and enhanced life satisfaction for patients with refractory angina pectoris. Enhanced external counterpulsation treatment should be considered to improve the life situation for these patients.

P2682Long-term effects of enhanced external counterpulsation treatment on symptom burden, usage of nitrates, physical capacity and health-related quality of life in patients with refractory angina pectoris

Abstract Background Patients with refractory angina pectoris (RAP) suffer from debilitating symptoms with considerable limitation of functional capacity and impaired health-related quality of life (HRQoL) despite optimized medical therapy. Recurrent angina symptoms are strongly associated with psychological distress and cardiac anxiety (i.e., a subtype of anxiety related to cardiac sensations). Enhanced external counterpulsation (EECP) is an alternative non-invasive treatment for these patients. An EECP course includes 35 1-hour sessions over 7 weeks. No previous study has explored long-term EECP effects on cardiac anxiety in patients with RAP. Objective To evaluate the effects of EECP treatment in patients with RAP regarding usage of nitrates, physical capacity, cardiac anxiety and HRQoL. Methods A quasi experimental design with long-term follow-up (6 months) involving 50 patients (men=37, 47–91 years) who had finished one course of EECP. Assessment of average use of nitrates, six-minute walk test, functional class with Canadian Cardiovascular Society (CCS) classification and questionnaires for cardiac anxiety and HRQoL were collected pre and post treatment. In addition, the questionnaires were collected 6 months after completion of EECP. Results Patients used significantly less nitrates (p&lt;0.001) compared to at the start of treatment. They enhanced the walking distance on average by 46 m after EECP (p&lt;0.001) and CCS class also improved (p&lt;0.001). All subscales except for one in cardiac anxiety were significantly reduced (p&lt;0.05). All dimensions in HRQoL improved significantly (p&lt;0.01). The positive effects in both cardiac anxiety and HRQoL were maintained 6 months after the treatment. Conclusions Patients with RAP received beneficial effects from EECP. Reduced symptom burden and improved physical capacity enable engagement in physical activities. Furthermore, less cardiac anxiety and improved HRQoL may enhance life satisfaction for these patients. EECP treatment should be considered to a greater extent to improve the life situation for these patients.

Abstract 11395: Enhanced External Counter Pulsation Improves Lipid Abnormalities in Patients With Chronic Ischemic Heart Disease

Introduction: Enhanced external counter pulsation (EECP) is effective in improving anginal symptoms in patients with ischemic heart disease (IHD); however its effect on the lipid profile has not yet been reported. Hypothesis: Exercise like peripheral muscle training effect of EECP could improve lipid profile. Methods: Two hundred and twenty nine consecutive patients, age 61.2+/-9.5 years, 207 (90.3%) males, left ventricular ejection fraction 35.5+/-11.7%, referred for EECP therapy between 2013 and 2016 were included in the study. All patients had symptomatic IHD and were on anti-ischemic and statin therapy. Patients were subjected to 35 EECP sessions of one hour each. All patients were subjected to a thorough clinical evaluation and a 12 hour fasting lipid profile estimation at the baseline and after completion of 35 sessions of EECP therapy. Concomitant medical therapy, including statins, remained unaltered during the course of EECP. Results: Significant improvement was noted in functional class, 6 minute hall walk test and activity scale after EECP therapy. Lipid abnormalities were common in these patients at baseline with 104 (45.4%) subjects having low density lipoprotein cholesterol (LDLC) &gt; 70 mg/dl, 128 (55.8%) having high density lipoprotein cholesterol (HDLC) &lt;35mg/dl and 79 (34.5%) having triglycerides &gt;140mg/dl. EECP resulted in significant improvement in lipid parameters in these patients- LDLC decreased by 18.5% (from 95.1+/-26.7 to 77.5+/-24.3 mg/dl, P value &lt;0.0001), triglycerides decreased by 18.9% (from 198.3+/-76.4 to 160.8+/-56.6 mg/dl, , P value &lt;0.0001) and HDLC increased by 14.2% (from 28.1+/-5.2 to 32.1+/-9.1 mg/dl, P value &lt;0.0001). The subgroups with worse baseline lipid levels showed larger improvement- patients having baseline LDLC &gt;100mg/dl showed 29.6% reduction in LDLC and those with HDLC &lt;25mg/dl showed 41.3% increase in HDLC after EECP therapy. Conclusions: Patients with IHD having abnormal baseline lipid levels despite statin therapy show significant improvement in LDLC, triglyceride and HDLC levels after EECP therapy. This improvement is likely to be due to the exercise like peripheral muscle training effect of EECP and needs further evaluation.

Experience of enhanced external counterpulsation application on dispensary-polyclinic stage rehabilitation of patients with refractory angina

The aim is to assess the efficacy and safety of enhanced external counterpulsation (EECP) application in patients with refractory class (RC) III-IV angina during the dispensary-polyclinic stage rehabilitation in real clinical practice.Materials and methods. EECP was held in 87 patients with RC III-IV effort angina as part of polyclinic stage of rehabilitation in the Department of prevention and rehabilitation Cardiology Dispensary. EECP was held using standard technique. Each patient received procedures prolonging for 35 hours. All patients underwent physical examination, stress testing, echocardiography, and the determination of highly-sensitive C-reactive protein (CRP) concentration and the speed of glomerular filtrate (SGF) rate was studied, before the inclusion in the study and after its ending.Results. On comparing the data received before and after the course of EECP we found the statistically significant improvement of patients’ functional status, the reduction in RC of angina, the reduction of the need for nitrate, the increase of the effort tolerance, the reduction of CRP concentration and increase of the SGF rate.Conclusion. The experience of EECP application in rehabilitation of patients with RC III-IV effort angina shows the high efficacy and safety.

Abstract P369: Impact of Enhanced External Counterpulsation on Exercise Duration in Patients With Chronic Stable Angina: A Meta-analysis

Introduction: Enhanced External Counterpulsation (EECP) is a non-invasive Food and Drug Administration approved treatment for patients with chronic stable angina and heart failure. Typical treatment regimen comprises of 35, 1-hour sessions of synchronized compressions of the calf, thigh, and sacral muscles over a seven-week period. Exercise duration measured using an exercise tolerance test is a commonly utilized marker of worsening ischemic disease and is predictive of cardiovascular mortality. Several studies have evaluated the impact of EECP on exercise duration with conflicting results. We sought to determine the magnitude of benefit of EECP on exercise duration. Methods: A literature search was performed in MEDLINE, CINAHL, and the Cochrane database along with hand searching of relevant articles limited to those published in the English language. Studies were included for analyses if assessing patients with stable angina and reporting exercise duration data using either the Bruce or modified Bruce exercise treadmill test. Appropriate data were extracted at baseline and after completion of the full course of EECP. Studies were excluded if presenting duplicate data or using a non-Bruce protocol. A weighted mean difference from baseline along with 95% confidence interval was calculated using the DerSimonian-Laird random-effects model. Sub-group analyses, the Cochran Q statistic, and JADAD scores were utilized to assess for heterogeneity, non-combinability, and quality of published studies respectively. Publication bias was assessed using visual inspection of funnel plots and the Egger bias statistic. Results: Our search strategy identified 1117 independent studies of which 15 were included for analyses. A total of 484 individual subjects were incorporated in the primary analysis. Exercise duration improved by 55.5 seconds (95%CI 36.1 to 74.9; Cochran Q, p=0.246) from baseline. The benefits were maintained when using a fixed-effects model, excluding small studies and limiting to studies using the Bruce protocol only. While the Egger statistic showed a lack of publication bias (p=0.121), it cannot be ruled out based on visual inspection of funnel plots. Conclusion: EECP significantly increases exercise duration by 56 seconds in patients with chronic stable angina. Further studies are needed to determine the impact of EECP on long-term outcomes. The views expressed in this material are those of the authors, and do not reflect the official policy or position of the U.S. Government, the Department of Defense or the Department of the Air Force.

Enhanced External Counterpulsation Has No Lasting Effect on Ambulatory Blood Pressure

Enhanced external counterpulsation (EECP) has been reported to reduce blood pressure (BP) using clinic BP readings. The aim of this study was to assess the effect of a course of EECP on BP using ambulatory BP (ABP) measurements. EECP has a lasting BP lowering effect. Patients referred for EECP due to refractory angina pectoris were consecutively included in the study. The ABPs were measured for 24 hours using a Spacelabs Ultralite 90217 device at 5 time points during the study period: 2 months before the EECP course, just before the EECP course, just after the EECP course, and at 3 and 12 months after EECP. Antihypertensive medication was held constant during the study period. Changes in BP were tested by repeated measures analysis. Fifty patients were included in the study. The mean age was 63 years, and 72% were male. The Canadian Cardiovascular Society Angina Grading Scale class improved from a mean of 2.6 to 1.5. The mean daytime ABPs were 114/69, 114/70, 115/71, 114/70, and 116/71 mm Hg and the mean nighttime ABPs were 107/63, 108/63, 106/62, 108/63, and 107/62 mm Hg at 2 months before the EECP course, just before the EECP course, just after the EECP course, and at 3 and 12 months after EECP, respectively (all P > 0.10). Further, when controlling for quartiles of baseline ABP level, no significant change in ABP was found. Enhanced external counterpulsation treatment has no lasting effect on ABP.

Comparison of Long Term Clinical Outcomes, Event Free Survival Rates of Patients Undergoing Enhanced External Counterpulsation (EECP) for Coronary Artery Disease in the United States and Turkey

This study assessed the long-term efficacy of EECP (Enhanced External Counterpulsation) in Turkish (TR) patients initially and compared these results with the United States (US) in a real world setting. In this study, 2072 patients were treated and followed in the US and 82 patients were treated and followed in TR. The International EECP Patient Registry Phase I and II was initiated and coordinated at the University of Pittsburgh. The aim of the "registry" was to assess the outcomes of clinical trials in a real world setting. Another unique feature of this study was to enroll patients not only from university hospitals but also from private hospitals, educational hospitals, and treatment centers. TR patients had less diabetes, hypertension, and hyperlipidemia than US patients (p<0.01). TR patients also had a higher proportion of diastolic augmentation (p<0.001). Both groups showed a significant reduction in the severity of angina after a 35 h EECP course (p<0.001). Major Adverse Cardiac Events (MACE) rate (death, coronary artery bypass graft, percutaneous coronary intervention, myocardial infarction) was low in both groups during treatment (2.5% vs. 2.7%). At 1 year follow up, 84% of TR and 76% of US patients had maintained the improvement of angina. Patients presenting for EECP treatment from TR had different baseline profiles from US patients. However, despite the high risk baseline characteristics, both cohorts achieved similar reduction in angina. In the long term follow-up, the MACE rate was low and the improvement after EECP was sustained in most of the patients.

Enhanced external counterpulsation improves systolic blood pressure in patients with refractory angina

Enhanced external counterpulsation (EECP) is a noninvasive treatment of patients with refractory angina. The immediate hemodynamic effects of EECP are similar to intra-aortic balloon pump counterpulsation, but EECP's effects on standard blood pressure measurements during and after treatment are unknown. We evaluated systolic blood pressure (SBP) and diastolic blood pressure (DBP) for 108 consecutive patients undergoing EECP. Baseline SBP, DBP, and heart rate were compared for each patient before and after each EECP session, at the end of the course of EECP, and 6 weeks after the final EECP session. One hundred eight patients (mean age 66.4 +/- 11.2 years, 81% male) completed 36.5 +/- 5.1 EECP sessions per patient. Overall, based on 3,586 individual readings, EECP resulted in a decrease in mean SBP of 1.1 +/- 15.3 mm Hg at the end of each EECP session (P < .001), 6.4 +/- 18.2 mm Hg at the end the course of EECP (P < .001), and 3.7 +/- 17.8 mm Hg 6 weeks after the final EECP session (P = .07), with no significant change in DBP or heart rate. Stratifying by baseline SBP, a differential response was demonstrated: SBP increased in the 2 lowest strata (<100 mm Hg and 101-110 mm Hg) and decreased in the remaining strata (P < .001). Stratified differences were sustained after individual EECP sessions, at the end of the course of EECP, and 6 weeks after the final EECP session and were independent of changes in cardiovascular medications. Enhanced external counterpulsation improved SBP in patients with refractory angina. On average, EECP decreased SBP during treatment and follow-up; but for patients with low baseline SBP (<110 mm Hg), EECP increased SBP. The improvements in SBP may contribute to the clinical benefit of EECP.

Long-Term Effect of Enhanced External Counterpulsation on Endothelial Function in the Patients with Intractable Angina

Enhanced external counterpulsation (EECP) is a noninvasive, pneumatic technique that provides favourable effects in patients with coronary artery disease. The objective of this study was to describe the long-term effect of EECP on endothelial function in patients with ischaemic cardiomyopathy. The study was performed in 15 patients with ischaemic cardiomyopathy. All subjects were treated with EECP 1-h per day, 5 days a week, over 7 weeks (totally 35h). Endothelium-dependent and -independent relaxation was assessed by flow-mediated dilation (FMD) and nitroglycerine-mediated dilatation (NMD). In each patient, FMD and NMD measurements were performed before, at midcourse (day 17th) and after completion of EECP course (day 35th). In addition, FMD index was assessed 1 month after completion of EECP therapy. Results showed that EECP was associated with a significant improvement in FMD index after 35 hours of EECP (10.95+/-4.1% vs. 7.40+/-4.9% for baseline, p<0.05). NMD index didn't significantly alter during the EECP therapy. Also, 1 month after completion of EECP, FMD index returned to baseline (7.51+/-4.4% vs. 7.40+/-4.9%, respectively, p<0.05). EECP acutely improved endothelial function in ischaemic cardiomyopathic patients. However, after 1 month completion of treatment, endothelium-dependent vasorelaxation returned to baseline. It seems that improvement of endothelial function is not the main mechanism of long-term EECP treatment and other mechanisms should be considered.

Does Completion of Enhanced External Counterpulsation Treatment Course Improve Outcomes in Heart Failure Patients?

Background: Enhanced External Counterpulsation (EECP) non-invasively improves quality of life and functional capacity in ischemic cardiomyopathy patients (pts). Whether completion of a 30hour course of EECP has durable benefits in decreasing heart failure (HF) decompensation and MACE in ischemic HF pts is unknown. Methods: The IEPR2 is a prospective, sequential registry of 3,000 EECP treated pts. EECP dropouts, when immediate treatment events are excluded, provide a comparator group of durable effects.

Enhanced External Counterpulsation in Patients with Coronary Artery Disease-Associated Erectile Dysfunction. Part II: Impact of Disease Duration and Treatment Courses

Enhanced external counterpulsation (EECP) is a noninvasive outpatient treatment used for patients with intractable angina refractory to aggressive surgical and medical treatment. Recent results have demonstrated a positive impact of EECP on patients with ischemic heart disease (IHD)-associated erectile dysfunction (ED). To assess the effect of IHD duration and number of EECP courses on efficacy and satisfaction rate of EECP on patients with IHD-associated ED. We compared pre- and post-EECP responses to erectile function (EF) domain, Q3 and Q4 of the International Index of Erectile Function score in patients who received one or two courses of EECP and those who had <5- or >or=5-years duration of IHD. As mentioned in part I a total of 44 male patients with intractable angina caused by coronary insufficiency were enrolled in this study. Treatment course of EECP consists of 35 1-hour sessions over 7 weeks. Another 35 1-hour sessions over another 7 weeks were offered to patients who received one course and required a second course because of no or minimal improvement from class IV to class III angina after the first course. Patients who received only one course (N = 34) had significantly higher EF domain, Q3 and Q4, in pre- and post-EECP results than patients who received two courses (N = 10) after they completed the first course. Patients who had <5-years duration of IHD had significantly higher pre- and post EECP than patients who had >or=5 years regarding EF domain, Q3 and Q4. Considering the global efficacy question, overall satisfaction, and angina, there were significant improvements of post EECP in patients with <5 years than in patients with >or=5-years duration of IHD. The efficacy and satisfaction rate of EECP in patients with IHD-associated ED were negatively influenced by longer duration of IHD and requirement of a second course of EECP.