EECP

Enhanced External Counter Pulsation (EECP)

REFERENCES

• ECP utilizes pneumatic cuffs on the lower extremities to provide diastolic augmentation & systolic unloading of blood pressure in order to decrease the cardiac work & oxygen consumption while enhancing coronary blood flow. Recent trails have shown that regular application improves angina, exercise capacity and regional myocardial perfusion being evidenced by Pre-& Post - EECP Stress Thallium.

Harrison's Principles of Int. Medicine: Edition 16th, Vol, II, Page 1441

• External Counter Pulsation is another promising alternative treatment of refractory angina. Data suggest that ECP reduces the frequency of angina and the use of nitroglycerin and improves exercise tolerance and quality to life. In a randomized, double-blind, sham controlled study of ECP for patients with chronic stable angina, counter pulsation was associated with an increase in time to ST segment depression during exercise testing and a reduction in angina. It also reduced the extent of ischemia detected with myocardial perfusion imaging.

Braunwald's text book of Cardiovascular Medicine: Edition 7th, Pages 1308

• EECP Uses cuff inflation for the application of compressed air-induced pressure to the lower extremities that is synchronized with the cardiac cycle. Specially, in early diastole, positive pressure is applied sequentially from the lower legs to the lower and upper thighs for the facilitation of increased retrograde aortic blood flow and increased coronary diastolic perfusion pressure. In patients with refractory angina, EECP is associated with a reduction in angina frequency and nitrate use, increased excercise lolerance, and improved quality of life. Those with severely limiting angina and without a smoking history are most likely to benefit. The favorable response to EECP observed in select patients with refractory angina has raised speculation that it should be implemented earlier in the treatment course.

Hurst's The Heart : Edition 13th, 2011 Vol ll, Pages 1485

• One case report illustrates capacity of EECP to revascularize the heart and control symptoms in patients who have not benefited from ballon angioplast or bypass surgery. The authors describe a 58 year old man who required two separate bypass surgeries, six rounds of angioplasty involving over 20 narrowing, multiple heart catheterizations, all within a 26 month time period. Finally, one artery closed off completely and further angioplasty was not possible. The patient was then begun on EECP and experienced a "dramatic" reduction in symptoms within 3 weeks. Upon completion of a 120 hour course, this patient's stress nuclear scan normalized and angina fully resolved. Three years out from EECP he remains asymptomatic.

Enhanced External Counterpulsation as an Adjunct to Revascularization in Unstable Angine.

Lawson, WE, Hui JCK, Oster Zh, et al. Clinical Cardiology 1997; 179-180

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