The role of enhanced external counter pulsation therapy in clinical practice

Abstract

Enhanced external counterpulsation (EECP) has been approved by the United States Food and Drug Administration (FDA) for management of refractory angina (Class IIb). EECP uses three sets of pneumatic cuffs that sequentially contract during diastole, increasing aortic diastolic pressure, augmenting coronary blood flow and central venous return. EECP improves anginal symptoms and exercise tolerance, and reduces nitroglycerin use in patients with chronic, stable angina. EECP has also been shown to be safe and beneficial in patients with symptomatic stable congestive heart failure. It has been postulated that cardiac benefits of EECP are mediated though vascular endothelial growth factor (VEGF) and nitric oxide mediated vasodilatation and angiogenesis. In June 2002, the FDA also approved EECP therapy for heart failure patients.

Keywords: Angina; Enhanced external counterpulsation (EECP); Heart failure; International EECP patient registry; Myocardial Infarction; Percutaneous Coronary Intervention.

Figure 1

Schematic of the sequential diastolic and systolic deflations of leg cuffs during EECP therapy.

Figure 2

Finger pleythysmogram showing the changes in vascular flow rate during EECP therapy; Blue curve indicates blood pressure without EECP; brown curve shows augmentation of blood flow as EECP cuff is inflated. [S: systole, D: diastole, T: transition (cuff inflation begins), EDP: end-diastolic pressure.]