EECP for Physicians
Overview
EECP therapy is a noninvasive treatment for patients with angina and heart failure. EECP treatment is typically provided on an outpatient basis in 35 one-hour sessions over a period of approximately seven weeks. Additional hours may be safely and effectively added to this standard regimen if physician evaluation of the patient’s response to treatment determines additional hours will result in greater relief of angina symptoms, i.e., “treating to target.” In certain circumstances, adjusting the patient’s treatment regimen to two hours per day can make it more comfortable for the patient to complete a course of EECP therapy.
To receive EECP therapy the patient lies on a treatment table. Compressive cuffs (similar to large blood pressure cuffs) are securely wrapped around the patient’s calves, thighs and buttocks. These cuffs inflate in a distal to proximal sequence in early diastole, and deflate simultaneously in late diastole just prior to the onset of systole.
Inflation and deflation are specifically timed to the patient’s ECG to optimize therapeutic benefit. The sequential cuff inflation creates a retrograde pressure wave that augments diastolic pressure, increasing coronary perfusion pressure and venous return to the right heart (increasing preload and cardiac output). Rapid, simultaneous cuff deflation decreases systemic vascular resistance, afterload, and cardiac workload.
Clinical studies and data from the International EECP Patient Registry (IEPR), coordinated by the Epidemiology Data Center at the University of Pittsburgh, continue to demonstrate that 70–80% of patients realize therapeutic benefit immediately upon completion of a course of EECP therapy. At patient follow-up, therapeutic benefit is enhanced at six months and sustained at 24 months post treatment.1
Quality-of-life measures from a randomized trial and registry studies show significant improvement in the patients’ ability to resume activities of daily living, social interaction, and recreational pursuits.1,2 Studies have shown that the hemodynamics of EECP therapy closely resemble those of the intra-aortic balloon pump (IABP),3 long held as the “gold standard” for circulatory support of hemodynamically compromised patients.
The magnitude of diastolic augmentation that can be achieved with EECP therapy was found comparable to that of the IABP, resulting in improved coronary blood flow with decreased cardiac workload. Michaels, et al,4 in a landmark cath lab study, demonstrated the hemodynamics of EECP in the central vasculature: 4
