External Counterpulsation In Patients Research Articles

Reduction in the risk of contrast-induced nephropathy using enhanced external counter-pulsation in patients with chronic kidney disease

Objective To evaluate the efficacy of EECP in the prevention of contrast-induced nephropathy (CIN) in patients with chronic kidney disease (CKD). Methods A prospective trial was undertaken in the participants. A total of 280 patients with an estimated glomerular filtration rate (eGFR) of <60 ml/min/1.73 m2 who underwent percutaneous coronary artery procedures were enrolled and divided into two groups: the control group (n = 100) and the EECP group (n = 180). All patients received extracellular fluid volume expansion therapy with 0.9% normal saline, and patients in the EECP groups were also treated with EECP. The renal function indexes of the two groups were determined 48–72 h after coronary artery procedures. Results In the EECP group, the BUN and serum creatinine (Scr) after coronary artery procedures were significantly lower than those before coronary artery procedures (BUN: 8.4 ± 3.5 vs. 6.6 ± 2.7 mmol/L, p < 0.001; Scr: 151.9 ± 44.7 vs. 144.5 ± 48.3 μmol/L, p < 0.001), while the eGFR was significantly increased (43.6 ± 11.4 vs. 47.1 ± 13.9 ml/min/1.73 m2, p < 0.001). The degree of Scr elevation was lower in the EECP group than in the control group (12.4 ± 15.0 vs. 20.9 ± 24.8 μmol/L, p = 0.026). Additionally, the EECP group had a lower incidence of post-procedures Scr elevation than the control group (36.5 vs. 48.0%, p = 0.042), a higher incidence of post-procedures eGFR elevation (62.2 vs. 48.0%, p = 0.021), and a lower risk of CIN (1.1 vs. 6.0%, p = 0.019). Conclusion EECP therapy has a protective effect on renal function and can reduce the risk of CIN in patients with CKD.

Effectiveness of different treatment regimens of enhanced external counterpulsation in patients with stable coronary artery disease complicated by heart failure

Aim. To study the effect of various therapy regimens with enhanced external counterpulsation (EECP) on exercise tolerance, quality of life, indices of structural and functional state of cardiovascular system in patients with stable coronary artery disease (CAD) complicated by chronic heart failure (CHF).Material and methods. The study included patients with stable CAD complicated by CHF with reduced and intermediate left ventricular ejection fraction (LVEF) from the randomized EXCEL trial (NCT05913778; n=120) and additionally patients with similar inclusion and exclusion criteria (n=90) who were randomized into groups with different EECP treatment regimens for 12 months: Group 1 (n=40): course of 35 hour-long procedures; Group 2 (n=40): course of 35 hourlong procedures every 6 months; Group 3 (n=30): course of 20 hour-long procedures then constantly 1 hour per week; Group 4 (n=30): constantly 2 hours per week; Group 5 (n=30): course of 20 hour-long procedures then constantly 2 hours per week; Group 0 (placebo ; n=40): course of 35 hour-long procedures with compression pressure 80 mm Hg. All patients at baseline and after 12 months were assessed for clinical status, quality of life (MLHFQ, SF-36), NT-proBNP levels, LVEF, as well as exercise tolerance (6-minute walk test; 6MWT) initially, after 3, 6, 9 and 12 months. Correlation analysis and risk assessment of adverse events (combined endpoint — combination of cases of adverse cardiovascular events, deaths, hospitalizations for CHF, new-onset of atrial fibrillation, diabetes, decreased renal function) was performed.Results. Treatment effectiveness had positive correlation with EECP duration (r(S)=0,670; p&lt;0,001) and treatment regimen (r(S)=0,620; p&lt;0,001). The maximum effect (changes in NT-proBNP levels, LVEF, clinical status, quality of life) was noted in the combined and constant regimen groups (5, 4, 2). The increase of 6WMTdistance was 6,6% in group 0, 24,9% in group 1, 44,5% in group 2, 31,8% in group 3, 49,1% in group 4, 58,6% in group 5. The proportion of patients with an increase in 6WMT-distance &gt;20% after 12 months was 7,7%, 72,5%, 97,5%, 76,7%, 90%, 100%, respectively. Cumulative event-free survival was highest in groups 5, 4, and 2 (0,97, 0,93, and 0,86, respectively), and the risk of developing combined endpoint in these groups was minimal (0,035, 0,075, and 0,150, respectively).Conclusion. The effect of EECP treatment in patients with coronary artery disease complicated by CHF depended on the EECP hours and regimen. Alternative EECP regimens (with more treatments spread evenly over the year) in addition to optimal medical therapy may improve the management of these patients.

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 Sky's the Limit: Expanding Nursing's Contribution to Acute Stroke Science.

Stroke is the number one cause of preventable disability in adults in the United States. Significant advances have occurred in medications and technology supporting rapid stroke diagnosis and treatment during the past 30 years, along with blurring of the lines of what traditionally constituted nursing or medical research. Ischemic stroke is a disease of vascular insufficiency that mirrors myocardial infarction more than any other neurologic diagnosis. My primary program of research is focused on exploration of methods to improve intracranial blood flow in patients with hyperacute ischemic stroke who have viable, yet vulnerable, brain tissue to prevent worsening or enable improvement of stroke symptoms. I am also examining augmentation of recombinant tissue plasminogen activator treatment and stimulation of both arteriogenesis and angiogenesis with external counter-pulsation in patients with intracranial atherosclerosis. My secondary program of research focuses on methods to improve stroke systems of care, including improvement of advance practice providers' contributions to acute stroke care, use of innovative mobile stroke units, and improvement of quality core measure processes. Lessons learned along the way are highlighted, along with the value of interdisciplinary "team science" to build knowledge and enhance the care of highly vulnerable patients with acute stroke.

The Sky’s the Limit: Expanding Nursing’s Contribution to Acute Stroke Science

Stroke is the number one cause of preventable disability in adults in the United States. Significant advances have occurred in medications and technology supporting rapid stroke diagnosis and treatment during the past 30 years, along with blurring of the lines of what traditionally constituted nursing or medical research. Ischemic stroke is a disease of vascular insufficiency that mirrors myocardial infarction more than any other neurologic diagnosis. My primary program of research is focused on exploration of methods to improve intracranial blood flow in patients with hyperacute ischemic stroke who have viable, yet vulnerable, brain tissue to prevent worsening or enable improvement of stroke symptoms. I am also examining augmentation of recombinant tissue plasminogen activator treatment and stimulation of both arteriogenesis and angiogenesis with external counterpulsation in patients with intracranial atherosclerosis. My secondary program of research focuses on methods to improve stroke systems of care, including improvement of advance practice providers’ contributions to acute stroke care, use of innovative mobile stroke units, and improvement of quality core measure processes. Lessons learned along the way are highlighted, along with the value of interdisciplinary “team science” to build knowledge and enhance the care of highly vulnerable patients with acute stroke.

Acute Hemodynamic Responses to Enhanced External Counterpulsation in Patients With Coronary Artery Disease.

Purpose: Enhanced external counterpulsation is a non-invasive treatment that increases coronary flow in patients with coronary artery disease (CAD). However, the acute responses of vascular and blood flow characteristics in the conduit arteries during and immediately after enhanced external counterpulsation (EECP) need to be verified.Methods: Forty-two patients with CAD and 21 healthy controls were recruited into this study to receive 45 min-EECP. Both common carotid arteries (CCAs), namely, the left carotid (LC) and right carotid (RC), the right brachial (RB), and right femoral (RF) artery were imaged using a Color Doppler ultrasound. The peak systolic velocity (PSV), end-diastolic velocity (EDV), mean inner diameter (ID), resistance index (RI), and mean flow rate (FR) were measured and calculated before, during, and after the 45 min-EECP treatment.Results: During EECP, in the CCAs, the EDV was significantly decreased, while the RI was markedly increased in the two groups (both P < 0.01). However, immediately after EECP, the RI in the RC was significantly lower than that at the baseline in the patients with CAD (P = 0.039). The FR of the LC was markedly increased during EECP only in the CAD patients (P = 0.004). The PSV of the patients with CAD was also significantly reduced during EECP (P = 0.015) and immediately after EECP (P = 0.005) compared with the baseline. Moreover, the ID of the LC, RB, and RF was significantly higher immediately after EECP than that at the baseline (all P < 0.05) in the patients with CAD. In addition, they were also higher than that in the control groups (all P < 0.05). Furthermore, by the subgroup analysis, there were significant differences in the FR, PSV, and RI between females and males during and immediately after EECP (all P < 0.05).Conclusions: Enhanced external counterpulsation creates different responses of vascular and blood flow characteristics in carotid and peripheral arteries, with more significant effects in both the carotid arteries. Additionally, the beneficial effects in ID, blood flow velocity, RI, and FR after 45 min-EECP were shown only in the patients with CAD. More importantly, acute improvement of EECP in the FR of the brachial artery was showed in males, while the FR and RI of the carotid arteries changed in females.

Acute Effect of Enhanced External Counterpulsation on the Carotid Hemodynamic Parameters in Patients With High Cardiovascular Risk Factors.

PurposeEnhanced external counterpulsation (EECP) can improve carotid circulation in patients with coronary artery disease. However, the response of carotid hemodynamic parameters induced by EECP in patients with high cardiovascular risk factors remains to be clarified. This study aimed to investigate the acute effect of EECP on the hemodynamic parameters in the carotid arteries before, during, and immediately after EECP in patients with hypertension, hyperlipidemia, and type 2 diabetes.MethodsEighty-three subjects were recruited into this study to receive 45-min EECP, including patients with simple hypertension (n = 21), hyperlipidemia (n = 23), type 2 diabetes (n = 18), and healthy subjects (n = 21). Hemodynamic parameters in both common carotid arteries (CCAs) were measured and calculated from Doppler ultrasound images. Peak systolic velocity (PSV), end-diastolic velocity (EDV), mean inner diameter (ID), systolic/diastolic flow velocity ratio (VS/VD), flow rate (FR), and resistance index (RI) were monitored before, during, and immediately after 45-min EECP.ResultsEDV and VS/VD were significantly reduced, while RI of CCAs was significantly increased among four groups during EECP (all P < 0.01). Additionally, the ID of CCAs and the FR of left CCA increased in patients with hyperlipidemia during EECP (P < 0.05). PSV of left CCA was reduced in patients with type 2 diabetes (P < 0.05). Moreover, immediately after EECP, ID was significantly higher in patients with hyperlipidemia. The RI of patients with hypertension and PSV and VS/VD of patients with type 2 diabetes were significantly lower compared with baseline (all P < 0.05).ConclusionEECP created an acute reduction in EDV, PSV, and VS/VD, and an immediate increase in the RI, FR, and ID of CCAs among the four groups. Additionally, a single 45-min session of EECP produced immediate improvement in the ID of patients with hyperlipidemia, the RI of patients with hypertension, and the PSV and VS/VD of patients with type 2 diabetes. The different hemodynamic responses induced by EECP may provide theoretical guidance for making personalized plans in patients with different cardiovascular risk factors.

Predictors of treatment benefits after enhanced external counterpulsation in patients with refractory angina pectoris.

BackgroundEnhanced external counterpulsation (EECP) is a noninvasive treatment that can decrease limiting symptoms in patients with refractory angina pectoris (RAP). Identifying responders to EECP is important as EECP is not widely available and relatively time intensive.HypothesisThe effect of EECP treatment on physical capacity in patients with RAP can be predicted from baseline patient characteristics and clinical factors.MethodsThis explorative study includes all patients from a cardiology clinic who had finished one EECP treatment and a 6 min walk test pre and post EECP. Clinical data, including Canadian Cardiovascular Society (CCS) classification and left ventricular ejection fraction (LVEF), were assessed before treatment. If patients increased their 6 min walking distance (6MWD) by 10% post EECP, they were considered responders.ResultsOf the 119 patients (men = 97, 40–91 years), 49 (41.2%) were responders. Multinomial regression analysis showed that functional status (i.e., CCS class ≥3) (OR 3.10, 95% CI 1.12–8.57), LVEF <50% (OR 2.82, 95% CI 1.02–7.80), and prior performed revascularization (i.e., ≤ 1 type of intervention) (OR 2.77, 95% CI 1.06–7.20) were predictors of response to EECP (p < .05, Accuracy 63.6%). Traditional risk factors (e.g., gender, smoking, and comorbidities) did not predict response.ConclusionsEECP treatment should be considered preferentially for patients that have a greater functional impairment, evidence of systolic left ventricular dysfunction, and exposure to fewer types of revascularization, either PCI or CABG. Improvement in 6MWD post EECP could imply improvement in physical capacity, which is a likely contributor to improved well‐being among patients with RAP.

The effectiveness of the method of external counterpulsation in patients with chronic stable angina

Aim. To assess the effectiveness of the complex treatment of patients with stable angina pectoris using the method of external counterpulsation (ECP).&#x0D; Methods. 92 patients with chronic stable angina were included in the comparative analysis, which divided into 2 groups: 57 patients received one course of treatment using the ECP method (main group), 35 patients received only drug treatment (control group). Before and after the therapy, a general clinical examination (including determining the functional class of angina pectoris and the need to use nitroglycerin preparations), coronary angiography, echocardiography, exercise stress test (stress ECG), and quality assessment using the Seattle Angina Questionnaire (SAQ) was performed.&#x0D; Results. The decrease in the average functional class of angina was more significant in the main group compare to the control group from 2.280.73 to 0.930.80 (p 0.05) versus from 2.340.73 to 1.830.71 (p 0.05). A decrease of at least 1 functional class more often occurred in the main group 78.9% of patients versus 57.1% (p=0.0258). The use of nitroglycerin sharply decreased after treatment in the group, that use the ECP method (by 51.6%; p=0.002), whereas in the control group, despite a slight decrease (by 22.7%), the changes did not reach statistical significance (p=0.0736). Both groups showed similar dynamics of changes in echocardiography. The differences were obtained only for the dynamics of the ejection fraction of the left ventricle (LVEF), which was greater in the main group an increase of 4.695.56% versus 1.755.15% (p=0.0448). The dynamics of all indicators of exercise stress test significantly differ between groups, and if for the main group it is positive, in the control group it is negative. Some indicators of quality of life change insignificant and similar for both groups (for example, on the scale for limiting physical exertion), and on some scales (stability scales for attacks and the frequency of angina attacks), the improvement in the main group is much more significant in comparing with the control group: 3037 points versus 1213 points, respectively (p 0.0001). The overall quality of life assessment score improved more in the group, that use the ECP method: +96.1040.73 versus +45.3135.06 the control group (p 0.0001).&#x0D; Conclusion. The method of external counterpulsation (ECP) can be used in clinical practice as part of a comprehensive treatment of patients with stable angina pectoris; it can significantly reduce the class of angina pectoris and the need to use nitroglycerin preparations, improve a number of indicators of echocardiography, electrocardiography with exercise and quality of life indicators.

The improvement of the shear stress and oscillatory shear index of coronary arteries during Enhanced External Counterpulsation in patients with coronary heart disease.

Enhanced External Counterpulsation (EECP) can chronically relieve ischemic chest pain and improve the prognosis of coronary heart disease (CHD). Despite its role in mitigating heart complications, EECP and the mechanisms behind its therapeutic nature, such as its effects on blood flow hemodynamics, are still not fully understood. This study aims to elucidate the effect of EECP on significant hemodynamic parameters in the coronary arterial tree. A finite volume method was used in conjunction with the inlet pressure wave (surrogated by the measured aortic pressure) before and during EECP and outlet flow resistance, assuming the blood as newtonian fluid. The time-average wall shear stress (TAWSS) and oscillatory shear index (OSI) were determined from the flow field. Regardless of the degree of vascular stenosis, hemodynamic conditions and flow patterns could be improved during EECP. In comparison with the original tree, the tree with a severe stenosis (75% area stenosis) demonstrated more significant improvement in hemodynamic conditions and flow patterns during EECP, with surface area ratio of TAWSS risk area (SAR-TAWSS) reduced from 12.3% to 6.7% (vs. SAR-TAWSS reduced from 7.2% to 5.6% in the original tree) and surface area ratio of OSI risk area (SAR-OSI) reduced from 6.8% to 2.5% (vs. SAR-OSI of both 0% before and during EECP in the original tree because of mild stenosis). Moreover, it was also shown that small ratio of diastolic pressure (D) and systolic pressure (S) (D/S) could only improve the hemodynamic condition mildly. The SAR-TAWSS reduction ratio significantly increased as D/S became larger. A key finding of the study was that the improvement of hemodynamic conditions along the LMCA trees during EECP became more significant with the increase of D/S and the severity degree of stenoses at the bifurcation site. These findings have important implications on EECP as adjuvant therapy before or after percutaneous coronary intervention (PCI) in patients with diffuse atherosclerosis.

The effectiveness of the method of external counterpulsation in patients with chronic stable angina

Purpose: to evaluate the effectiveness of multipurpose treatment of patients with chronic stable angina pectoris using the method of external counterpulsation (ECP). Materials and methods: a total of 92 patients with chronic stable angina included in the comparative analysis, which divided into 2 groups: the main group and the control group. The main group consisted of 57 patients who received one course of treatment using the ECP method, the control group consisted of 35 patients. Before and after the treatment, all patients underwent the following: general clinical examination, including the determination of the functional class of angina pectoris and the need to use nitroglycerin preparations; echocardiographic examination; stress-ECG test; quality of life assessment (based on the Seattle Quality of Life Questionnaire (Seattle Angina Questionnaire)). Results: a decrease in the average functional class of angina pectoris noted more in the ECP group than in the control group (from 2.280.73 to 0.930.80, p0.05 vs. from 2.340.73 to 1.830.71, p0.05). A decrease in the functional class of angina at least in one functional class was significantly higher in the main group (78.9% vs. 57.1%, p=0.0258). The use of nitroglycerin sharply decreased after treatment in the ECP group (by 51.6%, p=0.002), and in the control group, despite a slight decrease (by 22.7%), the changes did not reach the level of statistical significance (p=0.0736). When comparing the dynamics of changes in echocardiographic parameters, the dynamics turned out to be approximately the same in both groups. Differences obtained only for the dynamics of the left ventricular ejection fraction, which was greater in the ECP group (an increase of 4.695.56% vs. an increase of 1.755.15%, p=0.0448). The dynamics of all indicators of the stress-ECG test is significantly different in the main and control groups, and the dynamics in the ECP group are positive, but in the control group are negative. When comparing the data of quality of life, the dynamics of changes on some scales are insignificant and the same for both groups, for example, on the physical limitation scale, but on some scales (scales of angina stability and angina frequency), the dynamics of improvement in the ECP group are much higher than in the control group (30-37 points vs. 12-13 points respectively, p0.0001). The overall quality of life assessment score improved significantly more in the ECP group than in the control group (+96.1040.73 vs. +45.3135.06, p0.0001). Conclusion: the study showed that the method of external counterpulsation can be used in clinical practice as part of the multipurpose treatment of patients with chronic stable angina. The use of this technique has significantly reduced the class of angina, reduced the need for using nitroglycerin preparations, and improved some number of echocardiographic, stress-ECG test and quality of life indicators.

Impact of external counterpulsation on microcirculation in patients with coronary heart disease complicated by chronic heart failure after surgical and endovascular myocardial revascularization

To study the impact of external counterpulsation (ECP) on endothelial function and microcirculation in patients after myocardial revascularization (stenting and coronary artery bypass grafting) for functional class (FC) II-III chronic heart failure (CHF). Sixty patients aged 50 to 75 years after myocardial revascularization for FC II-III CHF were examined. All the patients received one-hour ECP sessions 5 times per week. The treatment cycle consisted of 35 sessions. To evaluate the microcirculatory bed, capillary blood flow was studied by laser Doppler flowmetry. The cycle of ECP in patients with FC II-III CHF after myocardial revascularization had a corrective effect on the microhemodynamic system. Microcirculatory changes were due to the normalized myogenic and neurogenic tone of arterioles and to increased oscillations in the endothelial range. The pronounced beneficial effect of ECP on the cardiovascular system in the examined patients was confirmed by a significant increase in exercise tolerance and by a statistically significant improvement in the results of 6-minute walk test. There was a decrease in FC heart failure. ECP is an effective, non-invasive treatment in patients with heart failure.

Experiences of Undergoing Enhanced External Counterpulsation in Patients With Refractory Angina Pectoris: A Qualitative Study.

Enhanced external counterpulsation (EECP) is a noninvasive treatment recommended for patients with refractory angina pectoris (RAP), which generally includes 35 one-hour sessions over 7 weeks. No study has described how patients experience the time before, during, and between sessions, as well as the time after EECP treatment. The aim of this study was to describe how patients with RAP experience EECP treatment. Semistructured interviews took place with 15 strategically selected patients (11 men, 58-91 years old) who had finished 7 weeks of EECP at the 2 existing EECP clinics in Sweden. Data were analyzed using inductive qualitative content analysis. The results were divided into 4 content areas, each comprising 3 categories: (1) experiences before EECP was initiated comprised uncharted territory, being given a new opportunity, and gain insight; (2) experiences during EECP sessions comprised physical discomfort, need of distraction, and sense of security; (3) experiences between EECP sessions comprised physical changes, socializing, and coordinating everyday life; and (4) experiences after 1 course of EECP treatment comprised improved physical well-being, improved mental well-being, and maintaining angina in check. Enhanced external counterpulsation was perceived as an unknown treatment option among these patients with RAP. Nurses should emphasize education before and during treatment based on individualized care needs to improve knowledge and treatment experience, as well as prevent discomfort. There is a great need to increase the awareness of EECP among healthcare professionals because it can improve the life situation for patients with RAP.

External Counterpulsation (ECP) Therapy as an Effective Treatment among Patients with Heart Failure undergoing Cardiac Rehabilitation

Background: External counterpulsation (ECP) is a noninvasive procedure using lower limbs pressure cuffs to improve coronary artery blood flow and offload the heart. There is currently no data on the effects of ECP among patients undergoing cardiac rehabilitation (CR). This pilot study aims to determine whether ECP improves exercise capacity among patients with heart failure or post acute myocardial infarction undergoing cardiac rehabilitation. Methods: This is a prospective randomised-controlled pilot study of the effect of ECP in patients with mild to moderate heart failure or post-acute myocardial infarction undergoing CR. Eligible patients were randomised at ratio of 1:1 to either combination of CR and ECP or CR only. All subjects received up to 16 sessions of conventional CR. For the combination arm, subjects received up to 16 one-hour sessions of one-hour ECP therapy following each CR session. All underwent baseline cardiopulmonary testing (CPET) and NT-Pro BNP determination and after completion of study. Results: A total of 4 patients were enrolled in the study from June 2016 to Jan 2017. Two were randomised to combination arm and two into CR arm. Post treatment VO2MAX improved 12 % in the combination arm (23.3±5.6 ml/min/kg from20.8±5.3 ml/min/kgat baseline) compare to 5% in the CR arm (23.0±6.2 ml/min/kg from21.9±2.3 ml/min/kg at baseline). There were no significant difference in the post treatment VO2MAX between groups, p=0.97. There was a 16% increased in post treatment maximum oxygen pulsein the combination group (14.4±1.0ml/beat from12.4±0.5ml/beat at baseline) compare to a 7.8% increased in the CR group (12.4±2.2ml/beat from11.5±1.4ml/beat at baseline). Interestingly, NT proBNP level worsened post treatment in the combination group (447.5±563.6 pre treatment to 472.7±560.5 post treatment), whereas improved in the CR only group (950.5±522.9 pre treatment to 327.5±202.6 post treatment). Conclusion: Cardiac Rehabilitation is known to improve exercise capacity among heart failure patients. ECP can further enhanced maximum oxygen consumption and maximum oxygen pulse in patients with mild to moderate degree of heart failure or post myocardial infarction undergoing cardiac rehabilitation. More studies with larger numbers are needed to prove this benefit of ECP.

Evaluation of the role of enhanced external counter pulsation in patients with chronic heart failure

Background: The incidence of Chronic Heart failure (CHF) has reached epidemic proportions in developing countries. The prevalence also increases as the patient population ages. Heart failure accounts for between 5% and 10% of all hospital admissions and is the most frequent cause of hospitalization in the elderly. The aim of this single centre observational study was to find out the efficacy of EECP in improving functional capacity and LV function in symptomatic chronic heart failure patients with mild to moderate LV dysfunction irrespective of their etiology.Methods: Thirty-six symptomatic patients in NYHA class II and III were included in this study. All the patients underwent one hour EECP therapy for thirty-five sessions over a period of seven weeks. NYHA classification, six-minute walk test, two dimensional and Tissue Doppler Echocardiographic examination were done before and after EECP therapy.Results: At the end of EECP therapy there was improvement in functional class. Eleven out of thirty-six patients were asymptomatic. The mean distance covered in six-minute walk test was also significantly increased after the therapy. The Echocardiographic parameters like Ejection Fraction (EF), Systolic excursion of mitral valve annulus (S'), Ratio between mitral flow E Velocity &amp; Mitral annular E velocity (E/E’) significantly improved after EECP.Conclusions: In this study, it was concluded that there was significant improvement in symptoms, functional capacity and LV function in Chronic Heart Failure patients after EECP therapy.

External Counterpulsation Increases Beat-to-Beat Heart Rate Variability in Patients with Ischemic Stroke

External counterpulsation (ECP) is a noninvasive method used to augment cerebral perfusion in ischemic stroke. However, the response of beat-to-beat heart rate variability (HRV) in patients with ischemic stroke during ECP remains unknown. Forty-eight patients with unilateral ischemic stroke at the subacute stage and 14 healthy controls were recruited. Beat-to-beat heart rate before, during, and after ECP was monitored. The frequency components of HRV were calculated using power spectral analysis. Very low frequency (VLF; <.04 Hz), low frequency (LF; .04-.15 Hz), high frequency (HF; .15-.40 Hz), total power spectral density (TP; <.40 Hz), and LF/HF ratio were calculated. In stroke patients, although there were no statistical differences in all of the HRV components, the HRV at VLF showed a trend of increase during ECP compared with baseline in the left-sided stroke patients (P = .083). After ECP, the HRV at LF and TP remained higher than baseline in the right-sided stroke patients (LF, 209.4 versus 117.9, P = .050; TP, 1275.6 versus 390.2, P = .017, respectively). Besides, the HRV at TP also increased after ECP compared with baseline in the left-sided stroke patients (563.0 versus 298.3, P = .029). Irrespective of the side of the ischemia, patients showed an increased beat-to-beat HRV after ECP. Additionally, sympathetic and parasympathetic cardiac modulations were increased after ECP in patients after right-sided subacute stroke.

Efficacy of Enhanced External Counterpulsation in Patients With Chronic Refractory Angina on Canadian Cardiovascular Society (CCS) Angina Class: An Updated Meta-Analysis.

A growing number of patients with chronic artery disease suffer from angina, despite the optimal medical management (ie, β-blockers, calcium channel blockers, and long-acting nitrates) and revascularization. Currently, enhanced external counterpulsation (EECP) therapy has been verified as a noninvasive, safe therapy for refractory angina. The study was designed to evaluate the efficacy of EECP in patients with chronic refractory angina according to Canadian Cardiovascular Society (CCS) angina class.We identified systematic literature through MEDLINE, EMBASE, the Cochrane Clinical Trials Register Database, and the ClinicalTrials. gov Website from 1990 to 2015. Studies were considered eligible if they were prospective and reported data on CCS class before and after EECP treatment. Meta-analysis was performed to assess the efficacy of EECP therapy by at least 1 CCS angina class improvement, and proportion along with the 95% confidence interval (CI) was calculated. Statistical heterogeneity was calculated by I2 statistic and the Q statistic. Sensitivity analysis was addressed to test the influence of trials on the overall pooled results. Subgroup analysis was applied to explore potential reasons for heterogeneity.Eighteen studies were enrolled in our meta-analysis. Pooled analysis showed 85% of patients underwent EECP had a reduction by at least one CCS class (95%CI 0.81–0.88, I2 = 58.5%, P < 0.001). The proportion of patients enrolled at primarily different studies with chronic heart failure (CHF) improved by at least 1 CCS class was about 84% after EECP (95%CI 0.81–0.88, I2 = 32.7%, P = 0.1668). After 3 large studies were excluded, the pooled proportion was 82% (95%CI 0.79–0.86, I2 = 18%, P = 0.2528). Funnel plot indicated that some asymmetry while the Begg and Egger bias statistic showed no publication bias (P = 0.1495 and 0.2859, respectively).Our study confirmed that EECP provided an effective treatment for patients who were unresponsive to medical management and/or invasive therapy. However, the long-term benefits of EECP therapy needed further studies to evaluate in the management of chronic refractory angina.

Is There Any Positive Remodeling after Enhanced External Counter Pulsation in Patients With Severe Refractory Angina?

Background: Patients with severe refractory cardiac angina who are not candidates for any form of invasive treatment and are already on optimal medical therapy have few therapeutic options. Enhanced external counter pulsation (EECP) offers an alternative palliative and possibly therapeutic option for these patients. EECP achieves this by inducing hemodynamic effects much similar to those of the intraaortic balloon pump. Objectives: We sought to further evaluate these therapeutic effects, especially on the basis of echocardiographic data. Patients and Methods: Thirty-two patients who had severe refractory angina despite full anti-ischemic medication and were poor candidates for invasive procedures were evaluated. After undergoing 35 sessions of EECP, the patients were followed up for 6 months for adverse events, change in quality of life, severity of the remaining symptoms according to the Canadian Cardiovascular Society (CCS) classification, and echocardiographic changes. Results: After receiving standard EECP treatment regimen, the patients showed a marked increase in quality of life scores; a significant decrease in left ventricular (LV) end-diastolic volume index after 6 months (P = 0.045), in tandem with an increase in the LV myocardial performance index (P = 0.04) with no significant change in the LV ejection fraction; and a significant decrease in the CCS scores (P = 0.01). In addition, physical performance measures, including time to unset of angina during the exercise test, were significantly increased. Conclusions: EECP is a useful and low-risk additive therapeutic option in patients with end-stage and non-responsive angina symptoms who are receiving optimal medical conventional treatments and are not good candidates for invasive procedures. This treatment can induce some positive remodeling in the LV.

Enhanced external counterpulsation in patients with refractory angina pectoris: a pilot study with six months follow-up regarding physical capacity and health-related quality of life

Refractory angina pectoris (AP) is a persistent, painful condition characterized by angina caused by coronary insufficiency in the presence of coronary artery disease. It has been emphasized that there are possible underlying neuropathophysiological mechanisms for refractory AP but chronic ischemia is still considered to be the main problem. These patients suffer from severe AP and cannot be controlled by a combination of pharmacological therapies, angioplasty or coronary bypass surgery. AP has a negative impact on quality of life and daily life. Enhanced external counterpulsation (EECP) is a therapeutic option for these patients. The aim of this study was to evaluate EECP after six months regarding physical capacity and health-related quality of life (HRQoL) in patients with refractory AP. This was a study with single case research experimental design involving 34 patients treated with EECP. Six minute walk test (6MWT), functional class with Canadian Cardiological Society (CCS) classification and self-reported HRQoL questionnaires as Short Form 36 (SF-36) were collected at baseline and after treatment. CCS class and SF-36 were repeated at six months follow-up. Patients enhanced walk distance on average by 29 m after EECP (p<0.01). CCS class also improved (p<0.001) and persisted at six months follow-up (p<0.001). HRQoL improved significantly and the effects were maintained at follow-up after the treatment. Patients with refractory AP receive beneficial effects from EECP both in physical capacity and HRQoL. As other treatment options for this patient group are scarce, EECP should be offered to improve physical health and HRQoL in these patients.

Enhanced External Counterpulsation in Patients with Advanced Ischemic Cardiomyopathy

Enhanced External Counterpulsation in Patients with Advanced Ischemic Cardiomyopathy B. Przywara-Chowaniec, M. Gawlikowski, A. Kuczaj, M. Bachorz, P. Czechowski, P. Kowalski, M. Geodecki, D. Kawecki, K. Bara«ska, M. Paluch, M. Pluszczyk, M. Opara, A. Puzio and E. Nowalany-Kozielska Silesian Medical University in Katowice, 2nd Department 1st Clinical Ward of Cardiology in Zabrze, Poland Foundation of Cardiac Surgery Development, Zabrze, Poland Institute of Medical Technology and Equipment, Zabrze, Poland