Background: The aim of this study was to echocardiographically assess the effects of EECP (Enhanced External Counterpulsation Therapy) therapy on systolic and diastolic cardiac function. Methods: LVEF (left ventricular ejection fraction), ESV (end-systolic volume), EDV (end-diastolic volume), Sm (myocardial systolic wave), Ea (myocardial early diastolic wave), Vp (propagation velocity), E/Ea (peak early diastolic transmitral flow velocity/Ea), E/Vp and diastolic function grade were studied in twenty-five patients before and after 35 hours of EECP. Results: EECP reduced ESV and EDV and increased EF significantly (p=0.018, 0.013, 0.002, respectively) in patients with baseline LVEF≤50%, but not in patients with baseline LVEF>50%. Patients with E/Ea≥14 had a significant reduction in EDV and ESV (p=0.038 and 0.32, respectively) and an increase in LVEF (p=0.007) after EECP, whereas patients with baseline E/Ea<14 had no significant change in these parameters. Similarly, EECP significantly improved ESV, EDV and LVEF (p=0.014, 0.032, 0.027 respectively) in patients with grades II and III of diastolic dysfunction (decreased compliance) at baseline, but not in patients with normal diastolic function or grade I diastolic dysfunction (impaired relaxation). Patients with Ea<7 cm/sec prior to EECP showed significant improvement in EDV, ESV and LVEF after therapy (p=0.024, 0.015, 0.001), while patients with Ea≥7cm/sec showed no significant change. Similarly, patients with Sm<7cm/sec prior to EECP showed significant improvement in EDV, ESV and LVEF after EECP (p=0.016, 0.017, 0.006), while patients with Sm ≥7cm/sec did not. Conclusion: These results provide new insight into the hemodynamic effectiveness and potential clinical applications of EECP.

Background and Objectives: Enhanced external Counterpulsation (EECP) was first introduced in the 1960s as a noninvasive procedure for the treatment of angina, refractory to medical therapy. Since its inception, technological advances have facilitated the procedure and rekindled interest in EECP as a mean to treat symptomatic Coronary artery disease and Acute hear failure. Here we studied the Effect of Enhanced External Counter pulsation on a group of patient with chronic heart failure.Materials and Methods: 30 consecutive patients (21 male, 9 female) were treated with EECP. Therapeutic effects of EECP on the quality of Life, echocardiographic parameters and 6 min. Walk test were assessed before and after the intervention.Results: A nonsignificant difference was found in scores of quality of Life between pre and post EECP treatment (p=0.1). Echocardiographic finding revealed significant improvement of (LVEDD), left ventricular ejection fraction (LVEF) by Simpson method (P=0.002) but the changes was not significant with MPI method (P=0.30). (LVESD) left ventricular end diastolic diameter (LVEDD) and left ventricular end systolic diameter (LVESD) were also significantly reduced after EECP intervention (p=0.032, p=0.015). Exercise duration in 6 min. walk test was significantly increased after treatment (p=0.0001).Conclusion: This study demonstrated that EECP improves exercise tolerance. But does not significantly improve the LVEF and quality of Life in patient with chronic heart failure.

Background: Enhanced external counter pulsation is a novel, potentially beneficial adjunctive therapy used for angina pectoris. We assessed the efficacy of this method in relieving angina and improving objective measures of myocardial ischemia.Methods: All the patients (67) who were referred for EECP to our department from 2002 through 2005 were included. Demographic data, CAD risk factors and baseline angiographic data were collected. Anginal symptoms, CCS functional class, echocardiography parameters (EF, LVESD, LVEDD) and exercise test duration before and after treatment were compared.Results: 77% of the patients who had undergone EECP had a positive clinical response. Exercise test duration and CCS functional class improved after the treatment. However, EECP had no significant effect on echocardiographic parameters. Efficacy was independent of age, gender, CAD risk factors, prior CCS functional class, echocardiographic parameters and baseline angiographic data. The patients without left main artery involvement demonstrated a greater likelihood of improvement.Conclusion: The results of this study suggested that EECP is a safe, well-tolerated and significantly effective treatment for angina pectoris.

Introduction: Coronary artery disease is the most common entity in cardiovascular medicine. There are different modalities for treatment: drug therapy and revascularization (PCI: Percutaneous Coronary Intervention & CABG: Coronary Artery Bypass). But quite a few patients experience intractable and disabling angina from the beginning due to inappropriate coronary anatomy or even after using therapeutic methods (full medical therapy, PCI, CABG). In such cases EECP (Enhanced External Counterpulsation), as an alternative and noninvasive therapy can decrease angina episodes and improve the quality of life.Materials and methods: Forty-four patients were included in this study. All had intractable angina despite full medical therapy and were not appropriate candidates for PCI & CABG, and this problem had notable effect on their life and work. EECP was done in 35 sessions (one hour daily) for all patients in Chamran Hospital-Isfahan. Exercise treadmill test was done before and after completion of the treatment course.Results: Treatment with EECP significantly increased exercise test time in this study. Mean exercise test time before and after completion of treatment was 192.65 and 341.38, respectively. After data analysis, a significant improvement was observed in exercise test time (P<0.001).Discussion: EECP in patients with refractory angina pectoris significantly increased exercise test time and consequently improved the patients' quality of life.

Introduction: Enhanced external counter-pulsation (EECP) is a non-invasive outpatient treatment used for angina pectoris. In patients with intractable angina who were symptomatic after medical and invasive strategies, several novel techniques are considered including EECP. EECP produces an acute hemodynamic effect that is presumed to be similar to that produced by the invasive intra-aortic balloon pump. By applying a series of compressive cuffs sequentially from the calves to the thigh muscles upon diastole and rapidly deflating the cuffs in early systole, an increase in diastolic and decrease in systolic pressure is created.Objectives: The purpose of this study was finding effects of EECP on status of myocardial perfusion in patients, unsuitable for invasive interventions.Methods: In this study, 50 consecutive patients (34 male, 16 female) with known coronary artery disease, which was found on coronary angiography, were treated with EECP and followed for one month post treatment. For all patients ECG Gated Myocardial Perfusion Single Photon Emission Computerized Tomography (SPECT) with 99mTc - MIBI in rest and stress was carried out before and one month after completion of treatment with 30 session EECP. Any differences in myocardial perfusion before and after EECP were compared qualitatively and semi-quantitatively and analyzed statistically.Results: The mean age was 62.18±8.67 years. A significant difference was found in Summed Rest Score (SRS) before and after EECP treatment (p=0.010). Differences between pre and post treatment Summed Stress Score were not significant (p=0.058). Before and after EECP treatment Summed Difference Score (SDS) were significant (p<0.001). End Diastolic Volume Index (EDVI), End Systolic Volume Index (ESVI) and Left Ventricle Ejection Fraction (LVEF) were not changed after treatment (p=0.67). Severity of ischemia is diminished significantly after EECP compared to before that (p=0.044), however, extent of ischemia showed no significant changes (p=0.105). Difference of fixed defects extension was also not significant before and after treatment (p=0.051).Conclusion: This study demonstrated that EECP is a useful method in improvement of myocardial perfusion in patients who are not suitable for intervention such as PCI and CABG, which is more prominent at rest status. So could be assumed that EECP augments angiogenesis in diseased myocardium after cardiovascular incidence.

Background: Enhanced external Counterpulsation (EECP) reduces angina pectoris, extends time to exercise-induced ischemia, and improves quality of life in patients with symptomatic stable angina. We aimed to evaluate the effects of EECP on heart rate recovery in patients with coronary artery disease (CAD). Methods: Between January 2011 and March 2013, a total of 34 consecutive patients (24 male, 70. 6%) with symptomatic CAD, who were candidated for EECP, prospectively received 35 sessions of 1-hour EECP therapy per day, 6 days per week. The patients underwent echocardiography and a symptom-limited modified Bruce exercise test before and after EECP. Left ventricular ejection fraction (LVEF), resting and peak exercise heart rates, systolic blood pressure, heart rate at 1 and 2 minutes of recovery, exercise duration, workload, and first-and second-minute heart rate recovery were measured before EECP and compared with those after EECP. Results: The mean age of the patients (70. 6% men) was 64. 82 ± 8. 28 years. After EECP, exercise duration increased significantly from 6. 48 ± 2. 76 minutes to 9. 20 ± 2. 71 minutes (p value < 0. 001). Maximum workload increased significantly (4. 44 ± 1. 28 vs. 5. 65 ± 1. 77 METS; p value < 0. 001). The LVEF increased from 42. 65 ± 11. 82% to 44. 26 ± 11. 86% (p value < 0. 001). The resting systolic blood pressure decreased significantly from 125. 59 ± 22. 35 mmHg to 116. 26 ± 14. 93 mmHg (p value = 0. 013). The increase in the first-and second-minute heart rate recovery after EECP was not statistically significant. Conclusion: The results of the present study showed that exercise duration, maximum workload, and the LVEF might increase significantly after EECP. The increase in the first-and second-minute heart rate recovery after EECP was not statistically significant.

Background & Aims: Enhanced external Counterpulsation (EECP) is a non-invasive outpatient treatment used for angina pectoris. In patients with intractable angina who were symptomatic after medical and invasive strategies, several novel techniques are considered including EECP. In patients with refractory angina due to coronary anatomy specific information, CABG or PCI are also up despite anti-ischemic drug therapy are still symptomatic, other treatments including EECP is used. EECP produces an acute hemodynamic effect that is presumed to be similar to that produced by the invasive intra-aortic balloon pump. By applying a series of compressive cuffs sequentially from the calves to the thigh muscles upon diastole and rapidly deflating the cuffs in early systole, an increase in diastolic and decrease in systolic pressure is created. The purpose of this study was finding relationship between the therapeutic effects of enhanced external Counterpulsation on refractory angina in patients, unsuitable for invasive interventions.Materials & Methods: In an Intermediary study, 50 consecutive patients (34 male, 16 female) were treated with EECP and followed for one year post treatment. Canadian cardiovascular society (CCS) class was analyzed, and medication and adverse clinical events were assessed prior to EECP, at the end of the treatment, and at 1 and 12 months thereafter. Any differences in background factors were recorded and analyzed.Results: The mean age of the 50 patients of this study was 62.18±8.67 years. A significant difference was found in score of life quality questionnaire between pre and after EECP treatment (p=0.010). Differences between EF pre and after treatment were significant (p=0.038). Differences between angina severity (CCS Score) pre and after EECP treatment were significant (p<0.001). Differences between Ischemia severity pre and after treatment were significant (p=0.044). Nitroglycerinusage pre and after treatment had no significant changes. Exercise duration significantly increased after treatment duration (p=0.001). LVEDD and LVESD also significantly reduced (p=0.031, p=0.032). Exercise test duration of one month after treatment than before treatment, and was significantly increased (p<0.001). However, the rate of improvement in the above parameters significantly after one year than a month after that story you did not treat the effects of relative stability is above. Amount of nitrates and other medications used before and after treatment statistically no significant difference in terms of study.Conclusion: This study demonstrated that EECP a useful method, while effective and safe for patients with severe refractory angina pectoris resistant to drug therapy and aggressive measures such as PCI and CABG are not suitable.

Background: The complicated concept of quality of life (QOL) has been considered as an important criterion for health outcomes in chronic diseases, such as heart disease, in recent years. The aim of this study was to evaluate the QOL of patients with angina pectoris after treatment with enhanced external Counterpulsation (EECP).Materials and Methods: This quasi-experimental study was conducted on 64 patients with angina pectoris undergoing EECP who came to Shahid Chamran and Sina Hospitals in Isfahan. Sampling was performed by the convenient method. Data were collected using a questionnaire containing socio-demographic and clinical data. A standard questionnaire called 36-item Short-Form Health Survey was also used. Questionnaires were completed through interviews and phone calls in three stages (before, immediately and three months after the treatment). The results were analyzed using descriptive statistics (frequency, mean, and standard deviation) and analytical statistics (paired t-test and repeated measures test) in SPSS11.5.Findings: The obtained results demonstrated that the majority of patients were men (59.4%) and aged 56-71 years. In addition, 57.8% had hypertension and 56.3% had hyperlipidemia. A history of myocardial infarction was found in 70.3% of the subjects and the familial history of coronary artery disease was detected in73.4%. Although QOL evaluations showed improvements in all subscales immediately and three months after the treatment, the changes were not statistically significant in case of general health, role limitations due to physical problems and role limitations due to mental problems.Conclusions: Similar to previous research, this study showed QOL to improve in patients who undergo EECP. This improvement will remain stable three months after the treatment in all subscales. Therefore, EECP is an efficient noninvasive method in treating patients with angina pectoris and in developing their QOL.

Enhanced external Counterpulsation (EECP) is believed to be a non-invasive treatment for coronary artery disease and angina. The aim of this study was to determine the safety and effectiveness of EECP in refractory angina patients through a systematic reviews and metaanalysis. We conducted a comprehensive search of the literature published on PubMed, Cochrane library, Scopus, Science Direct, Trip Database and Google Scholar databases using appropriate keywords and specific strategy with no time limit. Having selected and screened the studies based on the defined inclusion and exclusion criteria and evaluating their quality based on the Cochrane checklist. For the meta-analysis, the Mantel-Haenszel method or the generic Inverse Variance was used. Analyses were done with Review Manager 5. 2 software. A number of 299 studies were initially reviewed and finally, seventeen studies were included in the meta-analysis based on the inclusion and exclusion criteria. Also, thirteen outcomes were analyzed and the results of meta-analysis in twelve outcomes including (Systolic Blood Pressure (7 studies), Diastolic Blood Pressure (7 studies), Pulse Pressure (4 studies), Mean Arterial Pressures (4 studies), Heart Rate (6 studies), Angina episodes (7 studies), Walking distance (2 studies), Canadian Cardiovascular Society classification (6 studies), Flow-Mediated Dilation (3 studies), Daily Nitrate Usage (4 studies), Exercise Treadmill Test-Time (2 studies), ST-segment depression (2 studies) demonstrated a significant clinical advantage in the EECP treatment effectiveness in patients with angina. No significant difference was observed regarding EECP usefulness (P = 0. 18) in the outcome of brachial artery diameter (2 studies). Based on the metaanalysis, the results indicate the safety and effectiveness of EECP in patients with angina pectoris and indicate the usefulness of this treatment in these patients. In general, the authors believe that the general conclusion in this regard requires some studies with a large sample size and a control group assignment.