Enhanced external counterpulsation improves exercise tolerance in patients with chronic heart failure.

OBJECTIVES: The PEECH (Prospective Evaluation of Enhanced External Counterpulsation in Congestive Heart Failure) study assessed the benefits of enhanced external counterpulsation (EECP) in the treatment of patients with mild-to-moderate heart failure (HF). BACKGROUND: Enhanced external counterpulsation reduced angina symptoms and extended time to exercise-induced ischemia in patients with coronary artery disease, angina, and normal left ventricular function. A small pilot study and registry analysis suggested benefits in patients with HF. METHODS: We randomized 187 subjects with mild-to-moderate symptoms of HF to either EECP and protocol-defined pharmacologic therapy (PT) or PT alone. Two co-primary end points were pre-defined: the percentage of subjects with a 60 s or more increase in exercise duration and the percentage of subjects with at least 1.25 ml/min/kg increase in peak volume of oxygen uptake (VO2) at 6 months. RESULTS: By the primary intent-to-treat analysis, 35% of subjects in the EECP group and 25% of control subjects increased exercise time by at least 60 s (p = 0.016) at 6 months. However, there was no between-group difference in peak VO2 changes. New York Heart Association (NYHA) functional class improved in the active treatment group at 1 week (p < 0.01), 3months (p < 0.02), and 6 months (p < 0.01). The Minnesota Living with Heart Failure score improved significantly 1 week (p < 0.02) and 3 months after treatment (p = 0.01). CONCLUSIONS: In this randomized, single-blinded study, EECP improved exercise tolerance, quality of life, and NYHA functional classification without an accompanying increase in peak VO2.     

The role of enhanced external counterpulsation in the treatment of angina and heart failure

As the incidence of angina and heart failure continue to rise, new therapeutic options will be needed to treat patients who remain symptomatic or who are intolerant to current treatment. Enhanced external counterpulsation (EECP) is a noninvasive modality being investigated in both angina and congestive heart failure patients. It 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. The present paper summarizes the current literature on the clinical use of EECP in angina and heart failure.     

Novel possibilities of antithrombotic therapy in patients with chronic heart failure

Modern approaches to prevention of venous thromboembolic complications in patients with chronic heart failure are analyzed in this review which contains results of large studies of low molecular weight heparins. In MEDENOX trial the use of enoxaparin in medical patients was associated with 63% reduction of risk of thrombosis. The authors own experience showed that 2 weeks of therapy with enoxaparin in patients with chronic stage IIB-III heart failure caused significant lowering of soluble fibrin-monomer complexes, fibrinogen, and index of turbo-dynamic potential. These changes evidenced for decreased intravascular blood coagulation. Thus enoxaparin can be effectively used for prevention of thrombosis and thromboembolism in patients with chronic heart failure. Novel antithrombotic agents fondaparinux, idraparinux, ximelagatran, recombinant thrombomodulin are perspective medications for prevention of venous thromboses and embolism in medical patients.     

Enhanced external counterpulsation in patients with heart failure: a multicenter feasibility study

To assess the feasibility of using enhanced external counterpulsation to treat patients with heart failure, 26 patients with stable heart failure (New York Heart Association classes II-III), with a left ventricular ejection fraction at or below 35%, and without fluid overload, were treated with enhanced external counterpulsation (1 hour daily, 5 days a week, to a total of 35 hours). Patients were followed for 6 months after completing the course of enhanced external counterpulsation. The primary parameter was safety as reflected by adverse events or by changes in laboratory parameters. Secondary end points included changes in exercise capacity and quality of life. There were no clinically significant problems associated with the administration of enhanced external counterpulsation. Significant improvements were seen in exercise capacity (peak oxygen uptake and exercise duration), and in quality of life assessments, at 1 week and 6 months after the course of enhanced external counterpulsation. This study suggests that enhanced external counterpulsation is safe and well tolerated in patients with stable heart failure, and that a randomized, controlled study of enhanced external counterpulsation in these patients is warranted.     

A new treatment modality in heart failure enhanced external counterpulsation (EECP)

Heart failure remains a significant health problem in the United States and in the world. Despite a surfeit of recent diagnostic and therapeutic advances, patients with heart failure remain inadequately helped. The overwhelming need for new and better therapies continues to stimulate scientists to investigate new technologies. Over the past several years the use of enhanced external counterpulsation as a treatment for chronic angina has steadily increased. Recently, its potential role in heart failure management has been shown. We review the role of enhanced external counterpulsation in heart failure management as an emerging noninvasive outpatient therapy.     

增强型体外反搏治疗对老年射血分数保留心力衰竭患者的疗效

目的:探讨增强型体外反搏(EECP)治疗老年左心室射血分数保留的心力衰竭(HFpEF)患者的作用和血流动力学效应。方法:回顾性分析2018年1月至2019年12月在山东大学齐鲁医院体外反搏中心登记治疗的66例老年HFpEF患者的临床资料。主要观察指标为6 min步行距离试验,次要指标为明尼苏达心力衰竭生活质量调查表(M...     

Effect of enhanced external counterpulsation treatment on mean platelet volume in patients affected by ischemic chronic heart failure

Mean platelet volume (MPV) is increased in chronic heart failure (CHF) and is an independent predictor of mortality in CHF patients. It is not known whether enhanced external counterpulsation (EECP) therapy leads to decreased MPV values or not. The purpose of this study was to examine the effects of EECP on platelet count and MPV values and to assess the influence of MPV on the risk of death and recurrent ischemic events in ischemic CHF patients. A total of 68 ischemic heart failure patients with CHF symptoms and refractory angina pectoris were included in the study, 47 consecutive patients (39 males and eight females) aged 44-82 years. Although follow-up period started after completion of EECP in treated patients, control group follow-up started at the end of 7-week treatment without EECP. All patients were monitored for a mean duration of 13?±?8 months (range, 1-36 months). The primary endpoints of the study were effects of EECP treatment on platelets after treatment period (7 weeks) and the recurrence of ischemic events. Secondary endpoint was cardiovascular death during the follow-up period. We observed a significant increase in platelet count and decrease in MPV levels (P?=?0.044 and P?=?0.004, respectively) in the control group. There were no significant differences in platelet count and MPV levels in the EECP group (P?>?0.05). After the treatment period, New York Heart Association functional classification (2.60?±?0.75 vs. 1.72?±?0.68, P?相似文献   

Enhanced external counterpulsation and future directions: step beyond medical management for patients with angina and heart failure.

Between 25,000 and 75,000 new cases of angina refractory to maximal medical therapy and standard coronary revascularization procedures are diagnosed each year. In addition, heart failure also places an enormous burden on the U.S. health care system, with an estimated economic impact ranging from $20 billion to more than $50 billion per year. The technique of counterpulsation, studied for almost one-half century now, is considered a safe, highly beneficial, low-cost, noninvasive treatment for these angina patients, and now for heart failure patients as well. 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, promotion of collateralization, enhancement of ventricular function, improvement in oxygen consumption (VO2), regression of atherosclerosis, and peripheral training effects similar to exercise. 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, and so on. This review summarizes the current evidence for its use in stable angina and heart failure and its future directions.     

Benefit and safety of enhanced external counterpulsation in treating coronary artery disease patients with a history of congestive heart failure.

Enhanced external counterpulsation (EECP) is used to noninvasively treat refractory angina patients, including those with a history of heart failure. The International EECP Patient Registry was used to examine the benefit and safety of EECP treatment, including a 6-month follow-up, in 1,957 patients, 548 with a history of heart failure. The heart failure cohort was older, with more females, a greater duration of coronary artery disease, more prior infarcts and revascularizations. Significantly fewer heart failure patients completed the course of EECP, and exacerbation of heart failure was more frequent, though overall major adverse cardiac events (MACE, i.e. death, myocardial infarction, revascularization) during treatment were not significantly different. The angina class improved in 68%, with comparable quality of life benefit, in the heart failure cohort. At 6 months, patients with congestive heart failure maintained their reduction in angina but were significantly more likely to have experienced a MACE end point.     

Mechanisms and evidence for the role of enhanced external counterpulsation in heart failure management

Balloon counterpulsation has gained widespread acceptance as a therapy for cardiogenic shock. However, over the past four decades a parallel method of noninvasive counterpulsation, enhanced external counterpulsation (EECP), has been defined and developed. Mechanisms of benefit for this technology continue to emerge and include enhanced coronary and other key target organ perfusion beds. Other mechanisms include angiogenesis and enhanced cellular metabolism. Beyond putative mechanisms there is ample evidence for improved and sustained outcomes in patients with and without left ventricular dysfunction. This evidence comes from long-term registry reports and randomized clinical trials. With respect to heart failure (HF), there is registry, pilot trial, and randomized clinical trial evidence of safety and efficacy. This paper summarizes some of the mechanisms and outcomes of EECP in HF patients and helps to elucidate the role of EECP in the management of patients with chronic HF.     

Angina patients with diastolic versus systolic heart failure demonstrate comparable immediate and one-year benefit from enhanced external counterpulsation

BACKGROUND: Enhanced external counterpulsation (EECP) is effective in treating angina in coronary artery disease patients. Whether EECP produces similar immediate and sustained benefits and freedom from adverse events (MACE) at 1 year in patients with severe systolic dysfunction versus diastolic dysfunction is unknown. METHODS AND RESULTS: Data of 746 angina patients with a history of heart failure enrolled in the International EECP Registry were divided into 2 groups: left ventricular ejection fraction (LVEF) < or =35% (S) and LVEF >35% (D). Mean LVEF was 51.0 +/- 10.2% in diastolic dysfunction (n=391) versus 26.3 +/- 6.9% in systolic dysfunction (n=355). At baseline, 92.0% of diastolic dysfunction and 90.9% of systolic had Canadian Cardiovascular Society Class III/IV angina with similar number of anginal episodes and nitroglycerin use. After 32 hours of EECP, angina was reduced by > or =1 class in 71.9% of diastolic versus 72.2% of systolic with similar decreases in anginal episodes and nitroglycerin use. At 1-year 78.1% of diastolic and 75.8% of systolic have less angina than pre-EECP. MACE at 1 year was also comparable (24.4 versus 23.8%). CONCLUSIONS: The benefits of EECP in heart failure patients were similar regardless of diastolic or systolic dysfunction. The improvement was sustained at 1 year with similar MACE.     

Enhanced external counterpulsation and future directions: step beyond medical management for patients with angina and heart failure

Between 25,000 and 75,000 new cases of angina refractory to maximal medical therapy and standard coronary revascularization procedures are diagnosed each year. In addition, heart failure also places an enormous burden on the U.S. health care system, with an estimated economic impact ranging from $20 billion to more than $50 billion per year. The technique of counterpulsation, studied for almost one-half century now, is considered a safe, highly beneficial, low-cost, noninvasive treatment for these angina patients, and now for heart failure patients as well. 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, promotion of collateralization, enhancement of ventricular function, improvement in oxygen consumption (VO2), regression of atherosclerosis, and peripheral training effects similar to exercise. 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, and so on. This review summarizes the current evidence for its use in stable angina and heart failure and its future directions.     

体外反搏对心肌缺血总负荷的干预效果

目的　观察体外反搏对心肌缺血患者的治疗效果。方法　对 2 8例心肌缺血患者应用动态心电图检测体外反搏前后的心肌缺血发作阵次及持续时间 ,并采用配对资料显著性检验进行统计学处理。结果　反搏前后心肌缺血发作阵次为 2 5 .8± 7.2 ,缺血总负荷为 2 90± 139.32 ,反搏治疗后分别为 5 .9± 3.2和 10 8.16± 65 .95 ( P<0 .0 1)。结论　体外反搏对改善心肌缺血总负荷有显著的治疗作用     

体外反搏对慢性心力衰竭PCI术后的临床疗效观察

目的探讨体外反搏（EECP）对女性慢性心力衰竭（CHF）患者PCI术后的疗效及安全性。方法选择53例CHF行PCI术的绝经后女性患者,随机分为EECP组和药物治疗组。EECP组在常规药物基础上加做EECP8周,药物治疗组只进行常规药物治疗。两组患者治疗前、后均检测6min步行距离及Tei指数。结果两组6min步行距离（m）（589．00±47．17、556．00±48．17）及Tei指数（0．38±0．11、0．45±0．12）与治疗前（465．50±41．80、467．75±40．76,0．57±0．12、0．56±0．13）相比差异均有统计学意义（P〈0．01）,两组之间比较差异有统计学意义（P〈0．05）。结论EECP可提高女性CHF患者PCI术后的心肌缺氧能力,改善心功能,提高运动耐量,值得临床推广。     

定期体外反搏对冠心病患者内皮脂酶的影响

目的探讨定期体外反搏对冠心病患者血浆内皮脂酶水平的影响和意义。方法选择冠心病患者65例,分为定期反搏组(30例)和药物治疗组(35例)。采用酶联免疫吸附双抗体夹心法定量测定两组血浆内皮脂酶水平,同时测定血脂(HDL-C、TG、LDL-C、TC)和C反应蛋白的水平。结果定期反搏组血浆内皮脂酶水平和C反应蛋白水平分别为(339.74±40.32)μg/L和(2.17±0.34)mg/L,药物治疗组分别为(745.12±51.15)μg/L和(2.50±0.44)mg/L,两组之间血浆内皮脂酶和C反应蛋白水平的差异均有统计学意义(均为P<0.05)。两组中的血浆内皮脂酶与C反应蛋白水平呈正相关关系(r=0.37,P<0.05),而血浆内皮脂酶与血脂无相关性。结论定期体外反搏治疗能显著降低冠心病患者血浆内皮脂酶水平,提示体外反搏改善血管内皮功能可能与这种机制有关。