EECP Case Studies References
List of references and studies about Enhanced External Counter Pulsation EECP ECP
1. “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 trials have shown that regular application improves angina, exercise capacity and regional myocardial perfusion.”
------------------------------------------------------- Harrison’s principles of Int. medicine: Edition 16th, Vol. II, Page 1441
2. “External counter pulsation is another promising alternative treatment of refractory angina. Data suggest that ECP reduce the frequency of angina and the use of nitroglycerin and improves exercise tolerance and quality of 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, Page 1308
3. “Million of cases treated with ECP, illustrates the capacity of EECP into revascularization the heart and control symptoms in patients who have not benefited from balloon angioplasty or bypass surgery. The author describe a 58 year old man who required two separate bypass surgery, six rounds of angioplasty involving over 20 narrowing and multiple heart catheterization, 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 Counter pulsation as an Adjunct to Revascularization in Unstable Angina Lawson WE, Hui JCK, Oster ZH, et al. Clinical Cardiology 1997; 178-180.
4. STONY BROOK TRIALS:
Open label studies on the safely and effectiveness of EECP in patient with chronic stable angina pectoris were conducted at the State University of New York at Stony Brook, beginning in1989 and was reported by Lawson el at in American Journal of Cardiology in 1992. All of those patients had incapacitating symptoms, refractory to medical therapy and external myocardial ischemia documented by thallium-201 perfusion imaging. All patients in this study showed a substantial improvement in symptoms with most reporting a complete absence of angina during normal activity. In addition, the majority of patients in this study showed a reduction in myocardial ischemia, with two-thirds demonstrating a complete absence of reversible defects. These results were accompanied by a significant increase in the mean duration of exercise during maximal stress testing of between 95 and 112 seconds.
5. INTERNATIONAL EECP PATIENT REGISTRY (IEPR):
In 1988, the International EECP Patient registry (IEPR) was established to document patient and characteristic for those undergoing EECP therapy, the safely and efficacy of EECP therapy and the therapy’s long term outcomes in the broader population. More than 6000 patients had been enrolled in the registry. An analysis of long-term outcomes suggests that the clinical benefits achieved are sustained upto three years following an initial course of treatment.
6. MUST EECP STUDY:
In 1995, a large randomized, controlled and double blinded multicentre trial on the efficiency of EECP in patients with chronic stable angina (MUST-EECP) was undertaken at seven leading university hospitals in the United States. The MUST EECP trial results were published in the Journal of the American Cardiology in June 1999”. A total of 139 patients were enrolled in this study and randomly assigned to active or sham group. Those assigned to the active group were given full pressure. Those randomized to the sham group were treated with low pressure. Patients enrolled in study ranged from 18-21 years of age, were classified as having DDS’ Class 1, 2, or 3 angina and had documented coronary artery disease, including a positive exercise stress test within 4 weeks of beginning EECP therapy.
Patient in the active EECP group demonstrated significantly increased time to exercise induced ST segment depression when compared to sham and baseline. Those in the active EECP group reported a significant decrease in the frequency of angina counts. Exercise duration increased significantly in both group but was greater in the active EP group.
7. OTHER STUDIES:
A study published in 2001 in the journal of American Collage of Cardiology by Urano at al. of Kurume University in Japan confirmed once more the benefits of EECP reported in the literature to date, a decline in anginal frequency, an increase in exercise capacity and a decrease in exercise induced in signs of myocardial ischemia. Additionally this study provides clear evidence that EECP improves diastolic filling in patients with coronary artery disease. The study showed that both the peak filling rate and the time to peak filling improved significantly. These indicators of improved cardiac function were also reflected in decreased levels of brain is secreted mainly by the left ventricle in response to stress and is a sensitive measure of cardiac function.
Here are some more links to case studies about EECP.
EECP Case Studies
Manchanda A, Soran O.
Enhanced external counterpulsation and future directions: step beyond medical management for patients with angina and heart failure.
J Am Coll Cardiol. 2007 Oct 16;50(16):1523-31. Epub 2007 Oct 1.
May O.
Residual high-grade angina after enhanced external counterpulsation therapy.
Cardiovasc Revasc Med. 2007 Jul-Sep;8(3):161-5.
Arora RR, Shah AG.
The role of enhanced external counterpulsation in the treatment of angina and heart failure.
Can J Cardiol. 2007 Aug;23(10):779-81. Review.
El-Sakka AI, Morsy AM, Fagih BI.
Enhanced external counterpulsation in patients with coronary artery disease-associated erectile dysfunction. Part II: impact of disease duration and treatment courses.
J Sex Med. 2007 Sep;4(5):1448-53. Epub 2007 Jul 18.
Werner D, Michalk F, Hinz B, Werner U, Voigt JU, Daniel WG.
Impact of enhanced external counterpulsation on peripheral circulation.
Angiology. 2007 Apr-May;58(2):185-90.
Lawson WE, Hui JC, Kennard ED, Soran O, McCullough PA, Kelsey SF; for the IEPR Investigators.
Effect of enhanced external counterpulsation on medically refractory angina patients with erectile dysfunction.
Int J Clin Pract. 2007 May;61(5):757-62.
El-Sakka A, Morsy A, Fagih B.
Enhanced external counterpulsation in patients with coronary artery disease-associated erectile dysfunction. Part I: effects of risk factors.
J Sex Med. 2007 May;4(3):771-9. Epub 2007 Apr 13.
Soran O, Kennard ED, Bart BA, Kelsey SF; IEPR Investigators.
Impact of external counterpulsation treatment on emergency department visits and hospitalizations in refractory angina patients with left ventricular dysfunction.
Congest Heart Fail. 2007 Jan-Feb;13(1):36-40. Erratum in: Congest Heart Fail. 2007 Mar-Apr;13(2):124.
Michaels AD, McCullough PA, Soran OZ, Lawson WE, Barsness GW, Henry TD, Linnemeier G, Ochoa A, Kelsey SF, Kennard ED.
Primer: practical approach to the selection of patients for and application of EECP.
Nat Clin Pract Cardiovasc Med. 2006 Nov;3(11):623-32. Review.
Feldman AM, Silver MA, Francis GS, Abbottsmith CW, Fleishman BL, Soran O, de Lame PA, Varricchione T; PEECH Investigators.
Enhanced external counterpulsation improves exercise tolerance in patients with chronic heart failure.
J Am Coll Cardiol. 2006 Sep 19;48(6):1198-205. Epub 2006 Aug 28.
Pettersson T, Bondesson S, Cojocaru D, Ohlsson O, Wackenfors A, Edvinsson L.
One year follow-up of patients with refractory angina pectoris treated with enhanced external counterpulsation.
BMC Cardiovasc Disord. 2006 Jun 15;6:28.
Silver MA.
Mechanisms and evidence for the role of enhanced external counterpulsation in heart failure management.
Curr Heart Fail Rep. 2006 Apr;3(1):25-32. Review.
Lawson WE, Hui JC, Kennard ED, Kelsey SF, Michaels AD, Soran O; International Enhanced External Counterpulsation Patient Registry Investigators.
Two-year outcomes in patients with mild refractory angina treated with enhanced external counterpulsation.
Clin Cardiol. 2006 Feb;29(2):69-73.
Loh PH, Louis AA, Windram J, Rigby AS, Cook J, Hurren S, Nikolay NP, Caplin J, Cleland JG.
The immediate and long-term outcome of enhanced external counterpulsation in treatment of chronic stable refractory angina.
J Intern Med. 2006 Mar;259(3):276-84.
Soran O, Kennard ED, Kfoury AG, Kelsey SF; IEPR Investigators.
Two-year clinical outcomes after enhanced external counterpulsation (EECP) therapy in patients with refractory angina pectoris and left ventricular dysfunction (report from The International EECP Patient Registry).
Am J Cardiol. 2006 Jan 1;97(1):17-20. Epub 2005 Nov 2.
Michaels AD, Barsness GW, Soran O, Kelsey SF, Kennard ED, Hui JC, Lawson WE; International EECP Patient Registry Investigators.
Frequency and efficacy of repeat enhanced external counterpulsation for stable angina pectoris (from the International EECP Patient Registry).
Am J Cardiol. 2005 Feb 1;95(3):394-7.
Bonetti PO, Holmes DR Jr, Lerman A, Barsness GW.
Enhanced external counterpulsation for ischemic heart disease: what's behind the curtain?
J Am Coll Cardiol. 2003 Jun 4;41(11):1918-25. Review.
Soran O, Crawford LE, Schneider VM, Feldman AM.
Enhanced external counterpulsation as a new treatment modality for patients with erectile dysfunction.
Urol Int. 1998;61(3):168-71.
Arora RR, Chou TM, Jain D, Fleishman B, Crawford L, McKiernan T, Nesto RW.
The multicenter study of enhanced external counterpulsation (MUST-EECP): effect of EECP on exercise-induced myocardial ischemia and anginal episodes.
J Am Coll Cardiol. 1999 Jun;33(7):1833-40.
Lawson WE, Hui JC, Cohn PF.
Long-term prognosis of patients with angina treated with enhanced external counterpulsation: five-year follow-up study.
Clin Cardiol. 2000 Apr;23(4):254-8.
Lawson WE, Hui JC, Soroff HS, Zheng ZS, Kayden DS, Sasvary D, Atkins H, Cohn PF.
Efficacy of enhanced external counterpulsation in the treatment of angina pectoris.
Am J Cardiol. 1992 Oct 1;70(9):859-62.
For more insight into ECP, refer to internet. Type “EECP” in any of the search engine to get an access to more then 1 lac clinical sites.
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