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Enhanced external counterpulsation (EECP)
The technique of counterpulsation, studied for almost one-half century now, is considered a safe, highly beneficial, low-cost, noninvasive treatment for these angina and heart failure patients.
A standard EECP treatment comprises 35 hours over 7 weeks. Cuffs wrapped around the lower extremities and the hips are inflated with air in each diastole and deflated instantly at onset of systole.
EECP has a long lasting effect on angina pectoris. Several studies using different methods of assessment with objective blinded methods, have shown that EECP-therapy reduces the ischemic area of the left ventricle.
EECP has been proven to provide symptomatic benefit in angina patients, but has not been proven to show an increase in life expectancy or decrease in cardiovascular events.
EECP in heart failure has been proven to be safe, but its efficacy is still uncertain.
Recent evidence suggests that enhanced external counterpulsation (EECP) therapy may improve symptoms and decrease long-term morbidity via more than 1 mechanism, including
- Improvement in endothelial function, reduction of inflammatory cytokines, Enhanced external counterpulsation (EECP), increases endothelial shear stress, on circulating levels of inflammatory biomarkers and adhesion molecules in patients with angina pectoris
- Promotion of collateralization, enhancement of ventricular function
- Improvement in oxygen consumption
- Regression of atherosclerosis
- Peripheral training effects similar to exercise
EECP treatment reduces arterial stiffness and improves wave reflection characteristics in patients with refractory angina. These changes decrease LV afterload and myocardial oxygen demand and reduce the number of angina episodes, therefore enabling patients to participate in continuous exercise programs which in turn may provide long-term benefits and sustained improved quality of life.
Numerous clinical trials in the last 2 decades have shown EECP therapy to be safe and effective for patients with refractory angina with a clinical response rate averaging 70% to 80%, which is sustained up to 5 years. It is not only safe in patients with coexisting heart failure, but also is shown to improve quality of life and exercise capacity and to improve left ventricular function long-term. Interestingly, EECP therapy has been studied for various potential uses other than heart disease, such as restless leg syndrome, sudden deafness, hepatorenal syndrome, erectile dysfunction etc.
A few video clips summarizing what EECP is :
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