Enhanced external counterpulsation (EECP) reduces angina

Patients with angina (chest pain) and left ventricular dysfunction respond very well to treatment using enhanced external counterpulsation (EECP), with little or no future heart failure events, according to researchers from the Cardiovascular Institute at the University of Pittsburgh Medical Center (UPMC).

The researchers suggest that EECP is an effective therapy for the 2.4 million Americans with coronary artery disease who are not candidates for invasive revascularization procedures, such as balloon angioplasty, heart bypass or stent implantation. Their findings were reported in the January issue of the American Journal of Cardiology.

EECP is a non-invasive circulatory procedure whereby long inflatable cuffs are wrapped around a patient's calves, thighs and buttocks. While the patient lies on a table, the cuffs are sequentially inflated while the heart is at rest (diastole), and then simultaneously deflated just before the heart begins to pump (systole). The heart rhythms are picked up through a computerized EKG machine. The benefits of EECP include increased blood flow to the heart and coronary arteries, thereby enabling the heart to perform at an optimal level.

Using data from the International EECP Patient Registry, the study included 363 patients age 67 and older with chest pain accompanied by severe left ventricular dysfunction. Patients underwent 32 one-hour EECP sessions five days a week for seven weeks. Prior to the study most of the patients reported that their quality of life was poor. Among the patients in the study, 85 percent previously had a heart attack, 72 percent had coronary bypass and 70 percent had some other type of invasive heart procedure. All patients were assessed at six months, one year and two years. By the end of the study, the patients reported significantly less chest pain and an improvement in quality of life. The overall two year survival rate was 83 percent and event-free survival rate was 70 percent. Forty-three percent of patients reported no hospitalizations and 81 percent had no congestive heart failure episodes. Additionally, more than half of the patients discontinued their nitroglycerin use.

"EECP is an effective, non-invasive treatment for congestive heart failure because it significantly reduces chest pain, increases exercise tolerance and reduces nitrate use," according to Ozlem Soran, M.D., M.P.H., associate professor of medicine research at the University of Pittsburgh Medical Center Cardiovascular Institute and director of the UPMC EECP Research Lab.

The U.S. Food and Drug Administration approved EECP as a treatment for angina in 1995. At that time, EECP treatment was considered contraindicated in heart failure patients. Due to feasibility studies initiated at the University of Pittsburgh, the FDA approved EECP for the treatment of heart failure in 2002. Since then, the procedure has widely been used for the treatment of chest pain and as adjuvant therapy for revascularization.

Collaborating with Dr. Soran on this study were Elizabeth D. Kennard, Ph.D. and Sheryl F. Kelsey, Ph.D., both from the department of epidemiology at the University of Pittsburgh Graduate School of Public Health, and Abdallah Georges Kfoury, M.D., from the University of Utah.