Enhanced External Counter Pulsation (EECP)

EECP (03)

What is EECP?

Enhanced External Counter Pulsation (EECP) is a non-invasive outpatient treatment that aims to lower the number and intensity of angina episodes which are commonly known as chest pain. These treatments are done in clinic and it’s administered through three pairs of external inflatable cuffs that are applied around calves, thighs and buttocks. These cuffs continuously inflate and deflate between the resting periods of the heartbeat and increases the blood returned to the heart.

The target of EECP treatments includes increasing the amount of blood returning to the heart, which in results helps supply more oxygen to the areas that lacks oxygen. With increased levels of oxygen, the heart can function more efficiently and therefore reduce chest pain

EECP treatment usually is completed within 7 weeks or 35 hours, with daily visits for one hour, Monday to Friday.

How did EECP start?

EECP treatments first started in China, where it has been extensively used since the 1960’s. In the last 10 years, it has been introduced to the United States where there are currently around 1200 machines in use for this treatment. The idea for EECP started from the development of the intra-aortic balloon pump (IABP). Intra-Aortic balloon pump has shown to increase the amount of blood that can be pumped out of the heart by inflating a balloon in the aorta between each heartbeat. Increase volume in the aorta results in more blood flow and therefore decreases how hard the heart has to work. The same principle is applied to EECP, but it’s taken one step further in increasing the amount of blood entering the heart, providing more blood for the heart to work with. This also decreases how hard the heart has to work, but on a greater scale for patients especially with a history of damaged heart tissues.

How does EECP work?

The exact mechanism of action of EECP is still under intensive research. However, multiple study suggest that EECP can assist in inducing the formation of collateral vessels in the coronary artery tree by stimulating the release of nitric oxide and other growth factors within the coronary arteries. Other study also reveals that EECP also may act as a form of passive exercise, leading to the same sort of persistent beneficial changes that is seen in the autonomic nervous system that are consistent with real exercise.

Who are the suitable candidates for EECP?

EECP is suitable for anyone who wants to improve their general health. EECP is also safe for patient who have had a coronary artery bypass graft (CABG) or stents placed in the coronary arteries with ongoing chest pain. EECP is also suitable for patients who had no prior bypass or stenting, but suffers from angina or chest pain. EECP has also shown significant improvement in patients with restless leg syndrome, erectile dysfunction, and retinal artery occlusion.

Who are not suitable for EECP?

  • Enlarged Heart ( Hypertrophic cardiomyopathy)
  • Congenital heart disease
  • Valvular disease
  • Patients with pacemaker
  • Atrial fibrillation
  • Pulmonary hypertension
  • History of blood clots
  • Peripheral vascular disease
  • Severe uncontrolled hypertension
  • Tachycardia (heart rate above 120 beats per minute)

What are the benefits of EECP treatment?

  • Increased oxygen supply to the heart
  • Decrease in chest pain
  • Improved ECG reading to exercise
  • Decrease in nitroglycerin use
  • Increase in energy
  • Increased exercise duration
  • Long term effects lasting up to 2 years

How effective is EECP?

Multiple studies have been done worldwide and suggest that EECP can be quite effective in treating chronic stable angina. Another study done showed that EECP significantly improved both the symptoms of angina, and an overall improvement of exercise tolerance in patients with coronary artery disease. EECP also significantly improves quality of life. One study that was conducted in the USA has shown that the improvements following a course of EECP seems to persist up to 5 years.

In conclusion

Studies have shown in patients with chronic stable angina and positive stress tests to completing 35 hours of EECP, shows significant increase in exercise time post EECP from baseline, and significant improved time to >1mm ST-segment depression in the EECP groups and these results were maintained 12 months after EECP treatments. Another studies demonstrated that 78% of patient had a reduction in >1 angina class and 38% of patients had improvement in at least 2 classes. At least a 50% reduction in frequency of angina was experienced by 76% of patients as well as improvement in quality of life assessment that was sustained for at least 2 years. One study that was conducted in 2008 concluded that patients had significant improvements in both weekly angina events and quality of life 3 years following completion of EECP therapy. In another study conducted for a period of 5 years, 33 patients with coronary artery disease, EECP treated patient had improvement in chest pain of 88%, comparable with placebo group that had only undergone medical and revascularization therapies. At a 5 year follow up, 64% of patients were alive without interim cardiovascular events or need for revascularization. Data also shows an 83% reduction in hospitalization rates compared to 6 months prior to EECP. Upon completion of EECP therapy, there were significantly lower rates of myocardial infarction, coronary artery bypass grafting and PCI mortality at 1 year among those who completed 35 hours of treatment compared to those who have not.

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