Research Paper

A 1974 JAMA study investigated External Counterpulsation (ECP) for cardiogenic shock after heart attacks, a condition with low survival rates. In the study, 20 patients received this non-invasive therapy, which uses external leg pressure to aid circulation. ECP significantly improved outcomes, with 9 out of 20 patients (45%) surviving, including seven long-term survivors. Positive responses to ECP typically occurred within the first few hours, with survivors showing rapid blood pressure improvement. The authors concluded that ECP is a promising and effective treatment, recommending early application.

A clinical trial involving 258 patients evaluated External Pressure Circulatory Assistance (EPCA) for acute heart attack patients experiencing mild left ventricular failure. Patients were randomly assigned to treatment or control groups. The study found EPCA significantly reduced hospital mortality in specific patient subgroups. For example, patients aged 46+ who received at least 3 hours of EPCA saw mortality drop to 8.3% versus 17.5% in controls. Those receiving 4+ hours of EPCA also had lower mortality (6.5% vs. 14.7%). Mortality due to cardiac pump failure also decreased. EPCA was also associated with reduced complications, including less chest pain and improved cardiac function at discharge. The procedure had no direct complications, though some discomfort was reported. These positive results support further use of EPCA in heart attack recovery.

A 3-year clinical study evaluated Enhanced External Counterpulsation (EECP) in 18 patients with severe chronic angina, unresponsive to other therapies. EECP is a non-invasive treatment that improves heart blood flow. Immediately after 36 hours of EECP, 78% of patients showed improved heart perfusion and angina relief. At the 3-year follow-up, 59% of available patients remained event-free with reduced angina and sustained improved myocardial perfusion. No direct complications were attributed to the procedure. The study concluded that EECP provides long-term clinical benefits and sustained improvement in myocardial perfusion for most chronic angina patients.

A study in Indonesia assessed Enhanced External Counterpulsation (EECP) for 38 coronary patients with stable angina. All had proven myocardial ischemia. Patients received 36 one-hour EECP sessions while continuing their medications. Results showed significant improvement in myocardial perfusion (86.8%) and exercise tolerance (94.2%). Angina symptoms and functional class also improved significantly. Patients tolerated EECP well, with no serious complications. The increase in exercise tolerance surpassed that seen in post-CABG training or exercise rehabilitation. The study concludes that EECP is a safe and effective non-invasive treatment and rehabilitation option for coronary patients with stable angina

A clinical study investigated if angiographic findings can predict the effectiveness of Enhanced External Counterpulsation (EECP) in coronary artery disease patients. EECP is a non-invasive treatment that improves coronary blood flow and aims to reduce angina and improve exercise tolerance. The study assessed patients’ coronary anatomy via angiography before EECP. Given that most chronic angina patients benefit from EECP, the research aimed to determine if specific angiographic characteristics could predict treatment response. The hypothesis was that more severe coronary disease might inversely correlate with EECP benefits. The study sought to identify angiographic markers for EECP effectiveness, potentially guiding patient selection. Previous research noted EECP’s benefits are maintained for up to three years.

A clinical study on Enhanced External Counterpulsation (EECP) investigated its impact on exercise hemodynamics and myocardial perfusion in 27 chronic stable angina patients. The goal was to understand if improved exercise tolerance post-EECP stemmed from cardiac, peripheral, or both effects. Eighty-one percent of patients showed improved exercise tolerance, and 78% had improved myocardial stress perfusion. Despite longer exercise duration, maximal exercise heart rate and blood pressure didn’t significantly increase. This suggests EECP’s benefits are due to both improved heart blood flow and altered exercise hemodynamics, possibly acting as a “training” effect by reducing peripheral resistance and heart rate response to exertion. Thus, EECP likely improves exercise tolerance through both cardiac and peripheral mechanisms.

This overview consolidates findings from clinical studies on Enhanced External Counterpulsation (EECP) for angina pectoris. EECP is a novel, non-invasive therapy that improves heart blood flow by augmenting diastolic pressure and enhancing collateral development. The paper synthesizes data highlighting EECP’s mechanisms and clinical outcomes. Multiple studies demonstrate its success in alleviating angina symptoms and objectively reducing myocardial ischemia. A key finding is the sustained benefit achieved from this intermittent therapy. The paper concludes that EECP holds significant potential as an additional therapeutic option for angina, advocating for its wider application in suitable patients.

This paper provides an overview of Enhanced External Counterpulsation (EECP), a non-invasive treatment for angina pectoris and other coronary conditions. EECP, cleared by the FDA for stable/unstable angina, MI, and cardiogenic shock, involves timed, sequential compression of lower extremity blood vessels. By enhancing diastolic pressure, EECP increases coronary blood flow to ischemic areas, providing sustained angina relief. The paper posits that this symptomatic relief is likely due to collateral development, essentially creating a natural bypass. EECP is presented as a safe, atraumatic alternative to invasive procedures like angioplasty and bypass surgery, expanding treatment options for coronary artery disease patients.

This clinical case study highlights Enhanced External Counterpulsation (EECP) as an adjunctive therapy for a patient with severe, recurrent unstable angina. Despite two surgical revascularizations and seven angioplasties over 26 months, the patient continued experiencing symptoms and perfusion defects. Following these conventional treatments, EECP was initiated, leading to angina relief and resolution of perfusion defects. Remarkably, the patient remained asymptomatic for 36 months, defying a history of frequent symptom recurrence. The study concludes that EECP is an effective non-invasive treatment for chronic stable angina and shows promise as an adjunctive therapy for unstable angina, even post-revascularization, offering hope for patients with persistent symptoms.

A clinical study evaluated Enhanced External Counterpulsation (EECP) for coronary artery disease patients whose symptoms persisted despite angioplasty or bypass, or who were unsuitable for these. Initial findings from 18 patients, all with significant angina despite prior interventions, showed substantial symptomatic improvement post-EECP. Thallium stress tests revealed ischemic defect resolution in 67%, and reduced ischemia in 11%. Long-term efficacy was confirmed over 3 years. EECP’s benefit is potentially due to developing collateral channels, acting as a non-invasive “revascularization.” A later study suggested at least one patent conduit might be crucial for EECP effectiveness. EECP appears a viable alternative or adjunctive therapy for refractory angina.

This paper synthesizes U.S. clinical research on Enhanced External Counterpulsation (EECP) for angina pectoris across various CAD severities. Studies consistently show high response rates (75-92%), with EECP improving angina, exercise tolerance, and myocardial perfusion. The mechanism involves increased diastolic pressure and retrograde aortic flow, enhancing heart blood supply, likely via collateral formation. A patent coronary conduit improves success. EECP’s benefits are sustained; most patients remain event-free for 3-7 years, with mortality comparable to conventional treatments. This highlights EECP as an effective and durable therapy for coronary artery disease

This paper reviews the historical development and physiological basis of Enhanced External Counterpulsation (EECP). Tracing its evolution, it highlights EECP’s dual goals: reducing cardiac workload and augmenting diastolic pressure to improve heart blood flow. The review synthesizes research on EECP’s mechanism—sequential lower limb cuff inflation and deflation precisely timed with the cardiac cycle. This effectively increases myocardial oxygen supply while decreasing demand. The paper affirms EECP’s consistent clinical benefits for angina, acute myocardial infarction, and cardiogenic shock, concluding its increasing role in cardiovascular therapy is supported by decades of research.

This study highlights the emerging role of Enhanced External Counterpulsation (EECP) as a non-invasive outpatient treatment for severe, chronic obstructive coronary artery disease (CAD). It presents three case studies from The Heart-Lung Center, where patients with persistent symptoms despite maximal medical therapy or invasive procedures (PTCA/CABG) received EECP. EECP contributed to stabilizing their coronary circulation, reducing symptoms, and improving quality of life. The paper suggests EECP can decrease emergency visits, hospitalizations for chest pain, and the need for repeated costly revascularizations. These cases demonstrate EECP’s effectiveness in stabilizing CAD when conventional therapies fall short, solidifying its role in comprehensive cardiopulmonary care.

This community hospital study presents 17 case reports demonstrating Enhanced External Counterpulsation (EECP) as an effective non-invasive outpatient treatment for angina pectoris, even in advanced CAD or after failed revascularization. EECP, involving sequential pneumatic compression, significantly relieved angina, especially with at least one patent coronary conduit. The benefits were sustained. While one patient couldn’t complete treatment due to dyspnea, the other 16 did. The study concludes EECP is effective as both a primary and adjunctive therapy for angina, highlighting its significant potential.

This paper overviews Enhanced External Counterpulsation (EECP) as a treatment for patients with persistent angina despite exhausted revascularization options. It addresses the clinical challenge of chronic ischemic heart disease when traditional treatments fail. EECP, a non-invasive technique, shows promise by increasing diastolic pressure and improving coronary perfusion, reducing anginal episodes and exercise-induced ischemia. While not a first-line therapy, editor comments reinforce EECP’s established research and its value for difficult cases. The conclusion suggests EECP is a valuable alternative for patients with refractory angina who are not candidates for revascularization.

This research paper, published in Urologia Internationalis in 1998 , investigates Enhanced External Counterpulsation (EECP) as a novel treatment for erectile dysfunction (ED). The study explored the effect of EECP on 13 patients with ED , who underwent 20 daily one-hour treatment sessions. The research concluded that EECP appears to be an effective treatment modality for patients with ED , noting a significant improvement in penile rigidity and peak systolic flow as measured by Doppler sonography , with no observed adverse effects. ” Reignite the Spark! This pioneering 1998 study in Urologia Internationalis reveals EECP, a non-invasive therapy, significantly improves penile rigidity and blood flow in men with erectile dysfunction. A daily hour for 20 days brought remarkable results with no side effects. EECP: a promising, non-surgical path to renewed vitality!

This research paper, published in Clinical Cardiology in 1998, investigates whether prior revascularization, specifically coronary artery bypass grafting (CABG), enhances the effectiveness of Enhanced External Counterpulsation (EECP) in patients with chronic angina. The study involved 60 patients with coronary artery disease (35 without and 25 with prior CABG) and assessed the benefit of EECP by improved radionuclide stress testing post-treatment. The findings indicate that EECP was highly effective in patients with unrevascularized single- and double-vessel CAD, and significantly more effective in patients with triple-vessel CAD and stenotic grafts who had undergone prior CABG compared to unrevascularized triple-vessel CAD patients (80% vs. 22%). The paper concludes that EECP has a new role as an effective treatment for post-CABG ischemia, even with extensive CAD or stenotic grafts.

This research paper, published in Clinical Cardiology in 1998, focuses on optimizing the hemodynamic benefits of Enhanced External Counterpulsation (EECP) to maximize its therapeutic effects. The study aimed to determine the optimal timing for cuff inflation and deflation during EECP treatment to enhance its impact on cardiac function and blood flow. While not detailing a specific new clinical trial’s results, the paper synthesizes existing knowledge to discuss strategies for achieving maximal diastolic augmentation and systolic unloading, which are the core mechanisms of EECP. It highlights the importance of precise timing, guided by the patient’s electrocardiogram (ECG), to increase coronary perfusion and overall cardiac output. The conclusion emphasizes that maximizing these hemodynamic effects is crucial for achieving the best clinical outcomes in patients undergoing EECP therapy.

This research paper, published in Journal of the American College of Cardiology in 1999, presents the findings of the Multicenter Study of Enhanced External Counterpulsation (MUST-EECP). This study investigated the effect of EECP on exercise-induced myocardial ischemia and anginal episodes in patients with stable angina pectoris. The study design involved 139 patients who were randomized to either active EECP treatment or a sham control group. Key findings demonstrated that patients receiving active EECP experienced a significant reduction in weekly angina episodes and nitroglycerin use, as well as an improvement in time to exercise-induced ST-segment depression compared to the sham group. This large, multicenter trial concluded that EECP is an effective non-invasive treatment for chronic stable angina, improving both symptoms and objective measures of myocardial ischemia.

This research paper, published in the Journal of the Arkansas Medical Society in 1999, outlines Enhanced External Counterpulsation (EECP) as a new, non-invasive therapeutic approach for patients with severe disabling angina, particularly those unsuitable for or refractory to conventional revascularization procedures. It presents a compelling case study of a 63-year-old male with extensive coronary artery disease and chronic, debilitating angina who experienced dramatic relief of symptoms and a significant reduction in nitroglycerin use after completing a 35-hour course of EECP, improving his quality of life. The paper also reviews the historical development and prior clinical trials of EECP, highlighting its physiological basis—increasing diastolic pressure and coronary perfusion—and its sustained benefits in improving myocardial ischemia.

This research paper, a “Medical/Surgical Brief Review” published in 1999, addresses the growing clinical challenge of managing patients with angina that persists despite prior revascularization procedures or aggressive medical therapy. It highlights that many patients remain symptomatic, and there are limits to repeat interventions. The paper discusses emerging therapies to enhance myocardial perfusion, particularly Enhanced External Counterpulsation (EECP), as a promising non-invasive technique that augments diastolic pressure to improve coronary blood flow and reduce anginal episodes and exercise-induced myocardial ischemia. It concludes that EECP offers a valuable alternative for patients with refractory angina who are not candidates for further revascularization.

Enhanced external counter pulsation: the Howard County experience in the first 18 patients This research paper, published in the Maryland Medical Journal in July/August 1999, details the experience of Howard County General Hospital with Enhanced External Counterpulsation (EECP) in its first 18 patients. The study investigated EECP’s effect on individuals suffering from persistent angina despite maximal medical, surgical, and catheter-based interventions. All subjects demonstrated significant improvement in their functional class after EECP treatment, aligning with broader national findings. The paper highlights EECP as a non-invasive therapy that uses sequentially inflated pneumatic cuffs to enhance coronary artery diastolic flow and decrease cardiac workload, ultimately improving ischemic burden and exercise tolerance. It concludes by advocating for increased utilization of this therapy, especially with growing physician awareness and recent Medicare approval.

This research paper, presented at the XXI Congress of the European Society of Cardiology in 1999, investigates the microcirculatory effects of Enhanced External Counterpulsation (EECP) using an acute myocardial infarction model in dogs. The study measured capillary density and diameter, revealing that EECP significantly increased capillary density in the infarct zone compared to controls (p<0.01). This finding suggests that a key mechanism by which EECP improves perfusion to ischemic myocardial regions is through the recruitment and potential growth of new collateral blood vessels. EECP works by using timed inflation and deflation of pneumatic cuffs on the lower extremities to enhance diastolic blood flow.

This research paper, published in CARDIOVASCULAR DISEASE MANAGEMENT in November 1999, provides an overview of Enhanced External Counterpulsation (EECP) as a significant non-invasive and cost-effective treatment option for patients with symptomatic ischemic heart disease. It particularly focuses on those for whom additional invasive revascularization procedures are not feasible or desired, highlighting EECP’s role amid the proliferation of interventional cardiac devices. The paper describes EECP as a procedure utilizing pneumatic cuffs on the lower extremities that are precisely timed to enhance diastolic blood flow to the heart and decrease its workload. It references studies demonstrating EECP’s ability to improve exercise tolerance, functional class, and overall quality of life, affirming its established safety and efficacy in providing sustained relief for chronic angina.

This research paper, published in Jpn Circ J (Japanese Circulation Journal) in 1999, presents a case study evaluating the effects of Enhanced External Counterpulsation (EECP) on regional myocardial and coronary blood flow reserve in a patient with multi-vessel coronary artery disease and re-stenosis, using Nitrogen-13 Ammonia PET imaging. The study, involving a patient treated with 35 hours of EECP, demonstrated significant increases in both baseline coronary perfusion and coronary flow reserve in all myocardial walls post-treatment. This objective evidence suggests that EECP effectively recruits and develops coronary collateral vessels, thereby improving myocardial blood flow in patients with chronic stable angina.

This research paper, published in Clinical Cardiology in 1999, reviews decades of studies supporting the hypothesis that Enhanced External Counterpulsation (EECP) provides long-term benefits in patients with angina secondary to chronic coronary disease, with numerous non-sham controlled trials recently substantiated by a multicenter, randomized trial. Although the precise cellular mechanism remains under investigation, recent scientific findings suggest that shear stress induced by chronic EECP exposure might lead to the release of various growth factors, subsequently stimulating angiogenesis (the formation of new blood vessels) in the coronary beds. The paper concludes that ongoing clinical trials, an international registry, and additional studies will further clarify the role of this novel therapy in cardiovascular management.

This research paper, published in Reviews in Cardiovascular Medicine in 1999, provides a comprehensive overview of the treatment strategies for stable angina pectoris, focusing on both symptomatic relief and the reduction of adverse clinical outcomes. It reviews established approaches, including various antianginal drugs and revascularization procedures like coronary artery bypass grafting and percutaneous transluminal coronary angioplasty. The paper highlights the well-established role of lifestyle modifications and certain medications in reducing adverse outcomes. Furthermore, it discusses emerging non-pharmacological therapies, including Enhanced External Counterpulsation (EECP), which is presented as a useful adjunctive therapy in the management of stable angina.

This research paper, likely published in Clinical Cardiology in 1999, introduces pneumatic external counterpulsation (EECP) as a novel, non-invasive alternative to traditional intra-aortic balloon counterpulsation for improving organ perfusion. It highlights EECP’s ability to achieve similar hemodynamic benefits, such as increased diastolic pressure and reduced afterload, while significantly lowering the risk of complications associated with invasive procedures. The paper summarizes evidence demonstrating EECP’s effectiveness in enhancing blood flow to critical organs, including the brain, kidneys, and myocardium, making it a promising adjunctive therapy for various cardiovascular conditions with minimal side effects.

This research paper, published in The American Journal of Cardiology in 2000, discusses Enhanced External Counterpulsation (EECP) as a new non-invasive treatment for patients suffering from refractory angina, meaning their symptoms persist despite conventional therapies like bypass surgery or angioplasty. The paper highlights EECP’s mechanism of action, which involves augmenting diastolic pressure and increasing coronary blood flow to ischemic areas of the heart. It consolidates findings from various clinical studies, emphasizing EECP’s ability to reduce anginal episodes, improve exercise tolerance, and enhance overall quality of life for this challenging patient population. The research suggests EECP offers a valuable alternative for those with limited revascularization options.

This research paper, published in Clinical Cardiology in 2000, presents a five-year follow-up study evaluating the long-term prognosis of patients with angina who underwent Enhanced External Counterpulsation (EECP). The study aimed to assess the effect of EECP on major adverse cardiovascular events (MACE) in patients with coronary artery disease who had not responded to conventional medical or surgical therapies. It tracked 33 patients, subgrouping them based on their early response to EECP as determined by radionuclide stress perfusion imaging. The findings demonstrated a favorable long-term prognosis for most EECP responders, with low rates of MACE over the five-year period, suggesting a sustained therapeutic benefit from the non-invasive treatment.

This research paper, published in Psychosomatics in 2001, investigates the impact of Enhanced External Counterpulsation (EECP) on the psychosocial state of patients with ischemic coronary artery disease. The study found that EECP treatment significantly improved patients’ overall perception of health and quality of life, as well as reducing levels of depression, anxiety, and somatization. Notably, improvements were more substantial in patients who showed objective evidence of ischemia resolution. The paper suggests that the observed reduction in depression scores, given its known link to cardiac mortality, could be a significant finding meriting further research into the broader benefits of EECP.

This paper was published in Year 2001 Month November IN Journal of Investigative Medicine. This study investigates the acute and chronic hemodynamic effects of Enhanced External Counterpulsation (EECP) in patients with angina pectoris. Utilizing the BioZ System, twelve hemodynamic parameters were measured after 1 hour (n=22) and 35 hours (n=16) of EECP treatment, compared to baseline. Acute EECP treatment significantly decreased cardiac output, stroke volume, contractility, afterload, preload, and myocardial energy production. After 35 hours, stroke volume, index of contractility, and thoracic fluid content were also reduced. These findings suggest that EECP’s hemodynamic effects differ from those of the intra-aortic balloon pump, challenging previous theories. Further research is needed to elucidate EECP’s mechanism and efficacy.

This paper was published in Year 2001 Month None (publication date is the same as the congress date, which is July 21-24, 2001 ) IN Heart Disease: New Trends in Research, Diagnosis and Treatment by MEDIMOND Medical Publications. This pilot study investigates if Enhanced External Counterpulsation (EECP) can reduce restenosis rates after coronary angioplasty (PTCA). Clinical restenosis occurs in up to 30% of patients within six months of treatment. Given EECP’s ability to augment nitric oxide production, researchers hypothesized it could mitigate endothelial dysfunction, a key factor in restenosis. 24 patients, one month post-PTCA, were randomized to EECP (15 pts) or control (9 pts). At 6-month follow-up, major adverse cardiovascular events (MACE) and recurrence of ischemia were observed in 13% of the EECP group versus 44% of controls (p < 0.10). This trend, despite the small sample size, suggests EECP may reduce post-PTCA restenosis, warranting further investigation.

This paper was published in Year 2001 Month January IN Clinical Cardiology. This study investigated the effectiveness of enhanced external counterpulsation (EECP) in patients with stable angina pectoris. The MUST-EECP study, a prospective, randomized, controlled trial, enrolled 139 patients. Results showed that EECP significantly improved exercise tolerance and reduced the frequency of anginal episodes and nitroglycerin use compared to the control group. Furthermore, 35 hours of EECP treatment led to a significant improvement in time to 1-mm ST-segment depression during exercise treadmill testing. The study concludes that EECP is an effective noninvasive treatment for patients with stable angina, offering significant clinical and objective benefits.

his paper was published in Year 2001 IN Heart Disease: New Trends in Research, Diagnosis and Treatment by Medimond Inc. This study investigated the effects of Enhanced External Counterpulsation (ECP) on demand ischemia and coronary collateral flow in patients with angina. The authors note that ECP, a non-invasive treatment, has shown clinical benefits in patients with chronic stable angina. They assessed myocardial ischemia using positron emission tomography (PET) scans before and after ECP treatment. The results indicated that ECP therapy significantly reduced demand ischemia and improved coronary collateral flow. This suggests a potential mechanism for the observed clinical improvements in angina patients receiving ECP.

This paper was published in Year 2002 IN Cardiology. This study presents interim results from the International EECP Patient Registry (IEPR) regarding the effect of enhanced external counterpulsation (EECP) on health-related quality of life (HRQOL) in patients with angina or ischemia. EECP is a noninvasive treatment for chronic stable angina. The study utilized the Seattle Angina Questionnaire (SAQ) and Short Form-36 (SF-36) to assess HRQOL in 1,281 patients before and after EECP therapy. Significant improvements were observed in all SAQ subscales, including physical limitation, anginal stability, anginal frequency, treatment satisfaction, and quality of life, as well as in SF-36 physical component summary and all SF-36 subscales, indicating that EECP significantly improves HRQOL in these patients.

his paper was published in Year 2002 IN Clin. Cardiol. Suppl. II, Vol. 25. This review summarizes various clinical trials of Enhanced External Counterpulsation (EECP) conducted since the 1960s. The majority of these studies investigated EECP’s use in patients with angina pectoris, with only one being randomized. These trials consistently demonstrated EECP’s benefits, including a reduction in anginal episodes, increased exercise times, and improved health-related quality of life scores. The International EECP Patient Registry is further expanding the data on outcomes after EECP treatment. The review concludes that EECP has proven valuable for patients with coronary artery disease and angina not amenable to conventional therapies.

This paper was published in Year 2002 IN Clin. Cardiol. Suppl. II, Vol. 25. This paper discusses the ongoing and planned clinical trials for Enhanced External Counterpulsation (EECP), reflecting continued strong interest in this treatment. Current research focuses on three key areas: validating existing indications, such as symptomatic coronary artery disease; exploring new indications, including congestive heart failure and blood glucose control in diabetic patients with angina; and further elucidating EECP’s mechanism of action. The Prospective Evaluation of EECP in Congestive Heart failure (PEECH) trial is highlighted as a significant randomized study for a novel indication. These studies aim to expand the understanding and application of EECP.

This paper was published in Year 2002 IN Clin. Cardiol. Suppl. II, Vol. 25. This paper provides a historical overview of Enhanced External Counterpulsation (EECP), emphasizing its role in treating angina, a persistent health issue. Since its development in the early 1960s, EECP technology has undergone significant refinement. It is presented as an effective, noninvasive method proven by numerous clinical trials to reduce the frequency and duration of anginal episodes and improve exercise capacity. Despite established benefits, the paper underscores the ongoing need for research to identify the most suitable patients for EECP and optimize its clinical application, contributing to its continued evolution as a therapeutic option.

This paper was published in Year 2002 IN Clin. Cardiol. Suppl. II, Vol. 25. This paper examines Enhanced External Counterpulsation (EECP) as a valuable treatment option for patients with chronic angina pectoris, especially those inadequately managed by conventional therapies like medication or revascularization. It highlights that despite significant advancements in cardiology, many patients still suffer from debilitating symptoms. With recent positive clinical trial results, the paper argues that EECP’s role in the treatment hierarchy for angina needs serious consideration. It also delves into potential mechanisms of action, such as improved collateral blood flow, suggesting that further research could solidify EECP’s position as an effective, non-invasive intervention for this patient population.

This paper was published in Year 2002 IN Clinical Cardiology. This study compares the baseline characteristics and 1-year outcomes of patients with stable angina pectoris undergoing Enhanced External Counterpulsation (EECP) versus Percutaneous Coronary Intervention (PCI). Analyzing data from 323 EECP patients (International EECP Patient Registry) and 448 PCI patients (NHLBI Dynamic Registry), the study found that EECP patients presented with significantly more comorbidities. They had higher incidences of prior PCI, coronary artery bypass grafting, myocardial infarction, congestive heart failure, and diabetes, alongside lower left ventricular ejection fractions. This comparison highlights that EECP is often utilized in a more complex and high-risk patient population with stable angina.

This paper was published in Year 2002 IN Clinical Cardiology. This study, utilizing data from the International EECP Patient Registry, investigated how the pattern of diastolic augmentation (DA) during Enhanced External Counterpulsation (EECP) correlates with clinical benefits. EECP is known to reduce angina and improve exercise tolerance. The hypothesis explored was that effective DA promotes coronary collateral formation, contributing to sustained benefits. Findings revealed that patients exhibiting the greatest increase in their DA ratio also experienced the most significant reduction in angina class, both immediately post-treatment and at six-month follow-up. This suggests that improved vascular tone induced during EECP therapy may be a key mechanistic factor in achieving clinical improvement.

This paper was published in Year 2002 IN Clinical Cardiology. This paper details the current application and patient selection criteria for Enhanced External Counterpulsation (EECP). Predominantly, EECP is used for symptomatic coronary artery disease patients who have not responded to medication or are unsuitable for revascularization. EECP offers consistent benefits, leading to its expanded use to a broader patient population than initially studied. While generally safe, EECP is not universally suitable, and Medicare reimbursement limitations remain a barrier to wider access. The paper underscores the importance of proper patient selection to maximize the benefits of this non-invasive therapy.

This paper was published in Year 2002 IN The Journal of Cardiovascular Management. This paper presents Enhanced External Counterpulsation (EECP) as a non-invasive, outpatient treatment for chronic cardiovascular conditions that are refractory to standard medical or surgical interventions. EECP is FDA-cleared for indications such as congestive heart failure and chronic stable angina. A typical treatment course involves 35 one-hour sessions, during which augmented diastolic pressure and retrograde flow enhance myocardial perfusion, while systolic unloading reduces cardiac workload and oxygen demand. The observed clinical benefits are attributed to these physiological effects, positioning EECP as a valuable therapeutic option for managing persistent cardiovascular challenges.

This paper was published in Year 2002 IN Circulation. This study directly investigated the physiological effects of Enhanced External Counterpulsation (EECP) by measuring intracoronary and left ventricular hemodynamics in patients during treatment. The findings revealed that EECP dramatically increased diastolic and mean intracoronary pressures, and intracoronary Doppler flow velocity. Simultaneously, it effectively decreased systolic pressure. These direct measurements provide crucial insights into EECP’s mechanism, demonstrating that it both augments coronary perfusion and reduces the heart’s workload. This objective evidence supports the observed therapeutic benefits of EECP for patients suffering from chronic, symptomatic angina pectoris.

This paper was published in Year 2002 IN Congestive Heart Failure. This report from the International EECP Patient Registry assessed the safety and efficacy of Enhanced External Counterpulsation (EECP) for chronic angina in patients with left ventricular (LV) dysfunction. Among 1402 patients, 312 had LV dysfunction (LVEF ≤35%). This group exhibited more severe baseline conditions, including longer histories of coronary artery disease, congestive heart failure, and myocardial infarction. Despite these complexities, patients with LV dysfunction experienced comparable acute symptomatic improvements in angina class and nitroglycerin use, and similar gains in exercise capacity, to those with preserved LV function. Notably, EECP was well-tolerated with no increased adverse events, indicating its safety and effectiveness even in this high-risk population.

This research paper was published in July/August 2002 in Congestive Heart Failure. In this paper, it was described that Enhanced External Counterpulsation (EECP) was investigated in a multicenter feasibility study involving 26 patients with stable heart failure (New York Heart Association [NYHA] classes II-III) and a left ventricular ejection fraction of 35% or less. The primary objective was to assess the safety of EECP, considering adverse events and changes in laboratory parameters, while secondary objectives focused on changes in exercise capacity and quality of life. The study concluded that EECP was safe and well-tolerated, with no clinically significant issues or worsening of heart failure directly attributable to its administration in this patient population. Furthermore, significant improvements were observed in both exercise capacity (measured by peak oxygen uptake and exercise duration) and quality of life assessments at 1 week and 6 months post-treatment. These beneficial effects were consistent across patients with both idiopathic and ischemic cardiomyopathy, suggesting that EECP holds promise for providing short- and long-term benefits to selected individuals with chronic stable heart failure, thereby warranting a larger, randomized controlled study.

This research paper was published in July/August 2002 in

Congestive Heart Failure. In this paper, it was described that Enhanced External Counterpulsation (EECP) was evaluated for its effects on stress radionuclide coronary perfusion and exercise capacity in patients with chronic stable angina pectoris. The study included 35 patients who completed 35 hours of EECP treatment over 7 weeks. Results showed significant improvement in exercise duration, time to 1-mm ST-segment depression, and total work performed. Furthermore, there was a significant reduction in the total number of reversible perfusion defects and the size of the largest reversible defect, indicating improved myocardial perfusion. The study concluded that EECP is a safe and effective noninvasive treatment for patients with chronic stable angina, leading to improved myocardial perfusion and exercise capacity.

This research paper was published in May 2003 in the Journal of the American College of Cardiology. In this paper, it was described that the study examined the effect of Enhanced External Counterpulsation (EECP) on endothelial function in 23 patients with refractory angina. Using reactive hyperemia-peripheral arterial tonometry (RH-PAT), a noninvasive method to assess peripheral endothelial function, measurements were taken before and after the first, midcourse, and last EECP sessions, and one month after treatment completion. The results indicated that EECP led to symptomatic improvement in 74% of patients. EECP was associated with a significant immediate increase in the average RH-PAT index after each treatment session, and this improvement persisted at the one-month follow-up. Notably, the RH-PAT index at one-month follow-up increased only in those patients who experienced clinical benefit. The study concluded that EECP enhances peripheral endothelial function, with beneficial effects lasting for at least one month in patients who show a positive clinical response. This suggests that improved endothelial function may be a contributing mechanism to the clinical benefits of EECP in individuals with symptomatic coronary artery disease.

This research paper was published in 2003 in Cardiology. In this paper, it was described that Enhanced External Counterpulsation (EECP) was evaluated as a potential initial revascularization treatment for patients with angina refractory to medical therapy. The International EECP Patient Registry (IEPR) was utilized to analyze a cohort of patients who chose EECP as their primary revascularization treatment (PUMPERS, n=215) and compared them to patients who had prior percutaneous coronary intervention (PCI) and/or coronary artery bypass graft (CABG) (non-PUMPERS, n=4,454). The study found that PUMPERS responded to EECP treatment with decreased anginal episodes and nitroglycerin use, and showed improvement in their Canadian Cardiovascular Society functional class, similar to previously revascularized patients. Treatment with EECP resulted in a sustained and often progressive reduction in angina over the succeeding 6 months. The findings suggest that EECP, as a noninvasive treatment, could potentially be considered as the primary revascularization intervention when medical therapy proves unsatisfactory. While the study leaves questions unanswered regarding its role as an alternative to invasive procedures for moderate- or high-risk patients, it promotes interest in further appropriately designed studies.

This research paper was published in May 2003 in the Journal of the American College of Cardiology. In this paper, it was described that Enhanced External Counterpulsation (EECP) has been shown to reduce angina and improve objective measures of myocardial ischemia in patients with refractory angina. Prospective clinical studies and large treatment registries indicate that a course of EECP is associated with a prolongation of the time to exercise-induced ST-segment depression and resolution of myocardial perfusion defects, as well as enhanced exercise tolerance and quality of life. The growing body of knowledge supporting the safety and beneficial clinical effects associated with EECP suggests that this therapy is a valuable treatment option, particularly for patients who have exhausted traditional revascularization methods but remain symptomatic despite optimal medical care. Despite its long history and increasing evidence of clinical benefit and safety, the exact mechanisms by which EECP exerts its effects are not yet firmly established. This paper serves as a state-of-the-art review, exploring the current understanding of EECP’s benefits and mechanisms in ischemic heart disease.

This research paper was published in 2003 in Cardiology. In this paper, it was described that Enhanced External Counterpulsation (EECP) was evaluated as a potential initial revascularization treatment for patients with angina refractory to medical therapy. The International EECP Patient Registry (IEPR) was utilized to analyze a cohort of patients with prior percutaneous coronary intervention (PCI) and/or coronary artery bypass graft (CABG) (n=4,454) compared with a group of patients (PUMPERS, n=215) who were candidates for PCI and/or CABG and chose EECP as their initial revascularization treatment. The PUMPERS responded to EECP treatment with decreased anginal episodes and nitroglycerin use, and showed improvement in their Canadian Cardiovascular Society functional class, similarly to previously revascularized patients. Treatment with EECP resulted in a sustained, and often progressive, reduction in angina over the succeeding 6 months. Given these findings, it is interesting to speculate on the possibility of using EECP as the primary revascularization intervention after medical therapy proves unsatisfactory. While the current study leaves questions unanswered regarding whether EECP should be used as a primary revascularization alternative or if it alters the risk of cardiac events and mortality sufficiently to justify its use in moderate- or high-risk patients, it will hopefully promote interest in appropriately designed studies to test these questions.

This research paper was published in May 2003 in the Journal of the American College of Cardiology. In this paper, it was described that the study aimed to examine the effect of Enhanced External Counterpulsation (EECP) on endothelial function in 23 patients with refractory angina. Reactive hyperemia-peripheral arterial tonometry (RH-PAT), a noninvasive method for assessing peripheral endothelial function, was used to take measurements before and after the first, midcourse, and last EECP sessions, as well as one month after treatment completion. The results showed that EECP led to symptomatic improvement in 17 (74%) of the patients. EECP was associated with a significant immediate increase in the average RH-PAT index after each treatment session, and this improvement persisted at the one-month follow-up. Notably, the RH-PAT index at one-month follow-up increased only in those patients who experienced clinical benefit. The study concluded that EECP enhances peripheral endothelial function, with beneficial effects lasting for at least one month in patients who show a positive clinical response. This suggests that improvement in endothelial function may contribute to the clinical benefits of EECP in individuals with symptomatic coronary artery disease.

This research paper was published in October 2003 in Frontiers in Coronary Artery Disease. In this paper, it was described that the International EECP Patient Registry (IEPR) was used to collect data from 60 sites on consecutive chronic angina patients treated with EECP. The study aimed to examine the effect of EECP on the functional status of patients and identify predictors of increased functional status. Functional capacity was measured using the Duke Activity Status Index (DASI), a 12-item patient-completed questionnaire, before and after EECP treatment. The Canadian Cardiovascular Society Classification (CCSC) of angina was used to monitor changes in angina. The majority of patients had severe angina, often with prior invasive revascularization but were not suitable for further procedures. The baseline functional status, measured by DASI, was poor but significantly improved after EECP treatment. Co-morbidities, while predictive of a low baseline DASI score, did not prevent functional improvement. EECP was found to be a safe and effective treatment for chronic angina, leading to a reduction in angina and a significant improvement in functional status, which was comparable to or even slightly better than improvements reported after angioplasty or bypass surgery in certain aspects. This improvement in functional status was observed across a diverse patient population with various comorbidities and anginal statuses.

This research paper was published in 2003 in a review paper titled Enhanced External Counterpulsation. In this paper, it was described that Enhanced External Counterpulsation (EECP) is a noninvasive technique designed to increase myocardial perfusion and reduce cardiac workload in patients with coronary artery disease. Recent trials have documented beneficial hemodynamic effects, and stress testing and radionuclide imaging have demonstrated improvements in functional capacity and myocardial perfusion. This procedure may be a therapeutic choice for patients with severe diffuse disease or those for whom repeat revascularization is not possible. The relatively low cost of the technique also makes it feasible for patients in developing countries. The paper reviews EECP as an alternative nonpharmacologic therapy for patients whose primary or repeat revascularization may not be appropriate or who do not respond to maximal medical management. It outlines the technique and history of EECP, noting its evolution over approximately four decades.

This research paper was published on August 15, 2003, in The American Journal of Cardiology. In this paper, it was described that data from the International Enhanced External Counterpulsation (EECP) Patient Registry (IEPR) were analyzed to identify patient characteristics influencing improvement in angina class with EECP treatment. The study found that patients with severely disabling angina at baseline, men, and those without a history of smoking were more likely to experience an improvement in their angina class after EECP. Conversely, patients with diabetes mellitus, a history of prior bypass surgery, and heart failure were less likely to benefit. Despite these factors, the overall success rate (defined as a decrease of at least one Canadian Cardiovascular Society (CCS) angina class) was approximately 70% even in subgroups with less favorable predictors like heart failure and diabetes mellitus. Overall, EECP was effective in improving angina by at least one CCS anginal class in 73% of patients, with a mean reduction in anginal episodes per week from 10.1 to 2.5 and nitroglycerin use from 9.5 to 2.7 times/week after treatment. The study highlights that EECP is a safe and effective noninvasive treatment for patients with coronary artery disease .

This research paper was published in 2003 in the American Heart Journal. In this paper, it was described that the study examined the baseline characteristics, angina response, and cardiac outcomes of 1532 patients, 43% of whom had diabetes mellitus, treated with Enhanced External Counterpulsation (EECP) for chronic stable angina. Patients with diabetes, on average, experienced 11 episodes of angina per week, and most had prior revascularization procedures (86%) or were considered unsuitable for additional procedures (87%). EECP treatment was completed as prescribed in 79% of patients, with a mean of 32 hours of therapy. Immediately after EECP, 69% of diabetic patients showed a reduction of at least one Canadian Cardiovascular Society angina class, and 72% maintained this reduction after one year. Significant improvements in quality of life were also observed. Despite the high-risk profile of the diabetic group, their one-year mortality rate was similar to that of coronary intervention registry populations. This study suggests that EECP can be a safe, effective, and well-tolerated treatment option for angina relief in select patients with diabetes.

This research paper was published in 2003 in the American Heart Journal. In this paper, it was described that the study examined the baseline characteristics, angina response, and cardiac outcomes of 1532 patients, 43% of whom had diabetes mellitus, treated with Enhanced External Counterpulsation (EECP) for chronic stable angina. Patients with diabetes, on average, experienced 11 episodes of angina per week, and most had prior revascularization procedures (86%) or were considered unsuitable for additional procedures (87%). EECP treatment was completed as prescribed in 79% of patients, with a mean of 32 hours of therapy. Immediately after EECP, 69% of diabetic patients showed a reduction of at least one Canadian Cardiovascular Society angina class, and 72% maintained this reduction after one year. Significant improvements in quality of life were also observed. Despite the high-risk profile of the diabetic group, their one-year mortality rate was similar to that of coronary intervention registry populations. This study suggests that EECP can be a safe, effective, and well-tolerated treatment option for angina relief in select patients with diabetes.

This research paper was published in 2003 in The American Journal of Geriatric Cardiology. In this paper, it was described that a prospective observational study was undertaken to determine if Enhanced External Counterpulsation (EECP) is a safe and effective treatment for angina in octogenarians. Data was examined from 3037 patients consecutively enrolled in the International EECP Patient Registry, with 249 (8%) being 80 years or older. Octogenarians were found to be more often female and to have a higher incidence of congestive heart failure compared to younger patients, and they were less likely to have undergone previous revascularization. Despite these differences, EECP treatment was well-tolerated across all age groups, with no difference in the rate of adverse events between octogenarians and younger patients. The study found that 76% of octogenarians achieved at least a one-class improvement in angina, and 62% experienced a reduction of two classes or more, which was comparable to the response seen in younger patients. This sustained improvement in anginal status was maintained at one year. The study concluded that EECP is a safe, effective, and well-tolerated treatment for chronic stable angina in the elderly, including octogenarians, and should be considered as a therapeutic option for this patient population.

This research paper was published in 2003 in the American Heart Journal. In this paper, it was described that the study examined the baseline characteristics, angina response, and cardiac outcomes of 1532 patients, of whom 43% had diabetes mellitus, treated with Enhanced External Counterpulsation (EECP) for chronic stable angina. Patients with diabetes were experiencing, on average, 11 episodes of angina per week , and most had been revascularized with prior percutaneous coronary intervention or coronary artery bypass graft surgery (86%). The majority (87%) were also considered unsuitable for further revascularization procedures. Treatment was completed as prescribed in 79% of patients, with a mean of 32 hours of therapy. Immediately after EECP, 69% of patients with diabetes showed a reduction in angina of at least one Canadian Cardiovascular Society angina class. This angina reduction was maintained in 72% of diabetic patients after one year. Significant improvements in quality of life were also observed. Despite the high-risk profile among the diabetic group, their one-year mortality was similar to that observed in coronary intervention registry populations. The study concluded that EECP can be a safe, effective, and well-tolerated treatment option for the relief of angina in selected patients with diabetes.

This research paper was published in February 2003 in Heart. In this paper, it was described that Enhanced External Counterpulsation (EECP) is a non-invasive outpatient treatment for angina pectoris. For patients with intractable angina that is refractory to aggressive surgical and medical treatment, EECP is considered among several novel strategies. EECP creates an acute haemodynamic effect similar to that produced by the invasive intra-aortic balloon pump. This is achieved by sequentially inflating compressive cuffs from the calves to the thigh muscles during diastole and rapidly deflating them in early systole, which increases diastolic pressure and decreases systolic pressure. Although data indicates improvement in angina with EECP, its role in treating angina pectoris is not yet well defined. Currently, EECP use should be limited to patients with debilitating (functional class III and IV) refractory angina pectoris who are not candidates for revascularization, remain symptomatic despite maximal antianginal pharmacotherapy, and have no contraindications to EECP use. The paper also provides a historical perspective of EECP, noting its evolution from invasive internal modalities to more feasible pneumatic devices, with widespread use in China for over two decades. A typical treatment course involves 35 one-hour sessions over seven weeks.

This research paper was published in June 2003 in Acta Neurologica Scandinavica. In this paper, it was described that the study evaluated the effects of Enhanced External Counterpulsation (EECP) on blood pressure (BP) and cerebral blood flow velocity (CBFV) in 23 healthy controls and 15 atherosclerotic patients. Intra-aortic counterpulsation is a commonly used cardiac assist device, but its effects on cerebral blood flow have been conflicting. EECP non-invasively reproduces these effects. The study monitored heart rate, beat-to-beat radial artery BP, and CBFV before, during, and after a 5-minute EECP session. Results showed that EECP induced a second increase in BP and CBFV during diastole, leading to a significant increase in mean BP and a decrease in systolic BP in both patients and controls. Mean CBFV increased in both groups during the first 5 seconds of EECP, and diastolic CBFV remained higher after 3 minutes of EECP. The study concluded that EECP acutely influences cerebral haemodynamics, but the long-term effects on cerebral blood flow and neurological function require further investigation.

This research paper was published in 2003 in Clinical Cardiology. In this paper, it was described that the study investigated the practicability and limitations of Enhanced External Counterpulsation (EECP) as an additional treatment for angina. Despite growing evidence of EECP’s effectiveness in reducing angina and myocardial ischemia, concerns about contraindications and the long duration of treatment prompted a systematic evaluation. The study assessed every consecutive patient with angina refractory to medical and interventional therapy over an 18-month period at a single center. The findings revealed that a significant portion of potential EECP candidates either had contraindications (e.g., severe heart failure, valvular disease, or arrhythmias) or faced practical challenges in adhering to the demanding treatment schedule. Out of 105 patients, only 28 were initially eligible for EECP, and further screening reduced the treated group to 25. For those who completed the standard 35-hour course of EECP, a substantial reduction in angina symptoms was observed, with 88% showing a decrease in angina class. Additionally, these patients demonstrated improvements in exercise capacity and myocardial perfusion defects. The study concluded that while EECP is effective for selected patients with drug-refractory angina, its broad applicability is limited by patient eligibility criteria and the significant time commitment required for treatment.

This research paper was published in 2004 in Clinical Cardiology. In this paper, it was described that the study examined the safety and effectiveness of Enhanced External Counterpulsation (EECP) therapy in patients with significant left main coronary artery disease (LMD) and angina. Out of 2,861 patients enrolled in the International EECP Patient Registry (IEPR), three groups were analyzed: those without LMD (n=2,377), those with LMD and prior Coronary Artery Bypass Graft (CABG) (n=431), and those with unbypassed LMD (n=53). Patients with LMD, regardless of prior CABG, were significantly more likely to have triple-vessel disease (98.1% and 88.7%, respectively) compared to those without LMD (55.4%). The majority of LMD patients (83.8%) had severe angina (Canadian Cardiovascular Society class III/IV). After EECP, a significant reduction in angina class was observed across all groups, including those with unbypassed LMD, with 88.7% of unbypassed LMD patients improving by at least one angina class. The study concluded that EECP is a safe and effective treatment for angina in patients with significant left main coronary artery disease.

the long-term outcomes of enhanced external counterpulsation in relieving angina and improving the quality of life in a large cohort of patients with chronic angina pectoris. Seventy-three percent had a reduction by ≥1 angina class at the end of treatment, and 50% reported an improvement in the quality-of-life assessment after enhanced external counterpulsation; these results were sustained at 2-year follow-up.

https://pubmed.ncbi.nlm.nih.gov/14969624/