EECP Enhanced External Counterpulsation. A Medical Services Presentation from Vasomedical, Inc.
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A Medical Services Presentation from Vasomedical, Inc.
EECP is a registered trademark of Vasomedical, Inc. © 1999 Vasomedical Inc.
Medication and lifestyle modification
Surgical and/or percutaneous intervention (about 1.2 million patients per year)
Not readily amenable to intervention (80 - 200 thousand)
In most patients, EECP treatment...
… both short-term and long-term
Coronary artery disease patients with angina pectoris refractory to medical therapy.
For patients with a diagnosis of disabling angina pectoris who, in the opinion of their cardiologists or cardiac surgeons, are not readily amenable to invasive procedures because…
upper thighs and buttocks
It is recommended that 2 hours daily treatment sessions are separated by a 30 minutes rest interval.
Early external counterpulsationdevices had hydraulic pulsator chambers.
1950’s: - Kantrowitz Brothers - diastolic augmentation
- Sarnoff - LV unloading
- Birtwell - combined concepts
- Gorlin - defined counterpulsation
1960’s: - Birtwell & Soroff - Dennis- Osborne - hydraulic external counterpulsation
1970’s: - Soroff - cardiogenic shock
- Banas - stable angina
- Amsterdam - acute MI
1980’s: - Failure to gain acceptance
- China; redeveloped technology- pneumatic system
- Soroff, Hui, Zheng collaboration at Stony Brook
Background:Of 18 patients with chronic angina refractory to medical therapy: - 8 had 19 prior revascularization attempts - 7 had 14 prior mycardial infarcts
Methods: 36 one-hour treatment sessions
Pre- and post-treatment thallium treadmill stress tests to
identical exercise times
Separate post-treatment maximal routine treadmill stress test
Results: All patients reported improvement in anginal symptoms:
- 16 patients (89%) reported no angina during usual activities:
- 12 patients (67%) with resolution of reversible perfusion defects
- 2 patients (11%) with improvement of reversible perfusion defects - 4 patients (22%) with no change
Lawson WE, Hui JCK, Soroff HS, et al. Efficacy of enhanced external counterpulsation in the treatment
of angina pectoris. Am J Cardiol. 1992;70:859-862.
Background: Clinical follow-up of 18 initially treated patients was conducted after 3 years
Methods: Repeat stress thallium test performed to same exercise duration as initial study
Results: Of 14 patients who showed resolution/improvement in initial study:
- 11 patients remained free of limiting angina
- 1 patient was lost to follow-up and 1 refused another stress test
- 1 patient had surgical revascularization, 1 patient had an MI
Of the remaining 10 patients, 8 retained benefits and 2 reverted to pre- treatment baseline perfusion defects despite symptomatic benefit
Lawson WE, Hui JCK, Zheng ZS, et al. Three year sustained benefit from enhanced external counterpulsation in chronic angina pectoris. Am J Cardiol. 1995;75:840-841.
Background:A five-year follow-up was conducted on 33 angina
patients treated between 1989 and 1992 with EECP,
to assess morbidity and mortality.
Methods: Review of patient records at 5 years post-EECP (range 4-7 years).
Results: 29 of 33 patients remained alive. Of these, 9 patients
were hospitalized (4 acute MI, 6 CABG/PTCA,
1 unstable angina and 1 other cardiac surgery).
Conclusions: Five-year survival without an interim event of 60% of patients treated with EECP appears similar to that seen
with comparable populations treated with CABG/PTCA.
Lawson WE, Hui JCK, Burger L, et al. Five-year follow-up of morbidity and mortality in 33 angina patient treated with enhanced external counterpulsation. J Invest Med. 1997;45:212A.
Results: In sixty patients with CAD, after EECP treatment, improvement or resolution of reversible radionuclide perfusion defects were seen in:
86% (18/21) of patients with residual 1-vessel disease
85%(17/20) of patients with residual 2-vessel disease
53%(10/19) of patients with residual 3-vessel disease
75%(45/60) of patients overall
Conclusion: A proximally patent conduit may be necessary to allow transmission of augmented diastolic pressure and flow to distal coronary circulation.
Lawson WE, Hui JCK, Tong G et al. Prior Revascularization Increases the Effectiveness of enhanced external counterpulsation? Clin. Cardiol. 1998; 21:841-844.
Lawson WE, Hui JCK, Zheng SZ et al. Can Angiographic Findings Predict Which Coronary Patients Will Benefit from Enhanced External Counterpulsation? Am J Cardiol 1996;77:1107-09
Results of The Multicenter Study of Enhanced External Counterpulsation (MUST-EECP): EECP Reduces Time to ST-Segment Depression and Episodes of Angina with Improved Long-term Quality of Life
Rohit R. Arora, MD; Tony Chou, MD; Diwakar Jain, MD;
Richard Nesto, MD; Bruce Fleishman, MD;
Lawrence Crawford, MD and Thomas McKiernan, MD
for the MUST-EECP Investigators
Columbia Presbyterian Medical Center Rohit Arora, MD
University of California San Francisco Tony Chou, MD
Yale University School of Medicine Diwakar Jain, MD
Beth Israel Deaconess Medical Center Richard Nesto, MD
Grant/Riverside Methodist Hospitals Bruce Fleishman, MD
University of Pittsburgh Medical Center Lawrence Crawford, MD
Loyola University Medical Center Thomas McKiernan, MD
Design: Multicenter, randomized, sham- controlled, double-blinded trial
Randomization: Even assignment to EECP group or sham group in blocks of 10
allocated to each center
Subjects: 139 patients with chronic stable angina pectoris (137 evaluable)
Duration: May 1995 - July 1997
of EECP on...Measured by…
Exercise ability Exercise duration Time to ST-segment depression
Clinical status Frequency of anginal episodes Intake of nitroglycerin
Adverse experiences Physical exams Lab tests Daily questions
Statistical analysis P-values calculated for between-group differences using Cochran-Mantel-Haenszel Chi-Squared tests for ordered categories stratified by investigator
21-81 years of age
Canadian Cardiovascular Society Class I, II, or III
Evidence of CAD by one of following criteria:
(1 or more major arteries with >70% stenosis) or
Documented evidence of MI or
Positive nuclear stress test, plus...
A positive exercise stress test within 4-week baseline periodMUST-EECP: Inclusion Criteria
Severe symptomatic peripheral vascular disease
History of varicosities, deep vein thrombosis, phlebitis and/or stasis ulcer
ABP > 180/100 mm Hg
Bleeding diathesis; Coumadin use with INR >2.0
Inability to undergo treadmill tests
Non-bypassed left main with >50%
Inability to consent and/or cooperate throughout study duration
Enrollment in cardiac rehab. program
Participation in other research study
Pregnant or childbearing potential without contraception
MI and/or CABG in prior 3 months
Cardiac catheterization in prior 2 weeks
Arrhythmias (AF or VPBs) interfering with triggering of EECP
Marked baseline ECG abnormalities limiting interpretation (digoxin use, LVH with strain, LBBB)
Permanent pacemaker or defibrillator
CHF (LVEF <30%)
Significant valvular heart disease
III23.9 22.7Years of angina (±SD)8.6 ± 7.9 4.1 ± 4.5p <0.01Previous MI 56.3 40.9p <0.05Previous CABG 46.5 37.9
Previous PTCA 38.0 33.3
% Active%Sham(n = 71) (n = 66)
p = ns
p = 0.01
Adjusted mean of change from baseline
P < 0.02
P < 0.05
Paresthesia 1 2
Edema, swelling 02
Skin abrasion, bruise, blister 213
Pain in legs or back 720
No. of patients reporting AE 17(25.8%) 39(54.9%)
Withdrew because of AE’s 17
P = 0.005
P = 0.01
P < 0.001
P < 0.001
Compared to sham, EECP:
Compared to baseline:
EECP was generally well tolerated but with significantly fewer adverse experiences reported in the sham group.
Before treatment, the first 1213 consecutive patients…
(With a mean of 9 angina episodes per week before treatment)