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increase in preload occurs simultaneously with diastole which happens to be the time during the cardiac cycle in which coronary perfusion occurs. So, by increasing the coronary perfusion, you allow more oxygen to perfuse the heart and ultimately generate more collateral circulation without actually increasing the work of the heart. Additionally, cardiac output is increased via the Frank-Starling mechanism secondary to the increased venous return. As the cardiac cycle progresses to systole, the cuffs on the extremities deflate, allowing for the increased cardiac output to adequately perfuse all tissues including the extremities.
37:
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To best understand the pathophysiology of the therapy it is easiest to understand what each step does. To begin with, as the cuffs on each leg inflate, starting at the calf and working up to the upper thighs, blood is propelled back to the heart thereby increasing the venous return or preload. This
94:
The FDA approved the CardiAssist ECP system for the treatment of angina, acute myocardial infarction and cardiogenic shock under a 510(k) submission in 1980 Since then, additional ECP devices have been cleared by the FDA for use in treating stable or unstable angina pectoris, acute myocardial
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monitors that monitor heart rate and rhythm. The most common type in use involves three cuffs placed on each leg (on the calves, the lower thighs, and the upper thighs (or buttocks)). The cuffs are timed to inflate and deflate based on the individual's
137:. During the inflation portion of the cycle, the calf cuffs inflate first, then the lower thigh cuffs, and finally the upper thigh cuffs. Inflation is controlled by a pressure monitor, and the cuffs are inflated to about 200
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Studies have found EECP to be beneficial for patients with erectile dysfunction and some COPD patients. Additionally, improvements in exercise endurance in the non-diseased patient has been found in research studies.
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Of note, therapies are tailored on an individual basis but beginning regimens tend to include daily one-hour treatments that occur 5 days of the week and last 6–8 weeks with an average overall of 35 hours.
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Some reviews did not find sufficient evidence that it was useful for either angina or heart failure. Other reviews found tentative benefit in those with angina that does not improve with medications.
550:
El-Sakka A, Morsy A, Fagih B (May 2007). "Enhanced
External Counterpulsation in Patients with Coronary Artery Disease-Associated Erectile Dysfunction. Part I: Effects of Risk Factors".
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Manchanda A, Soran O (October 2007). "Enhanced external counterpulsation and future directions: step beyond medical management for patients with angina and heart failure".
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Soran O (August 2014). "Alternative therapy for medically refractory angina: enhanced external counterpulsation and transmyocardial laser revascularization".
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due to lack of blood flow, a 2012 Cochrane review found significant neurological improvement, but insufficient evidence to make reliable conclusions.
157:, and that this results in the production of a cascade of growth factors that result in new blood vessel formation in the heart (arteriogenesis and
223:"Enhanced External Counterpulsation Efficacy on Exercise Endurance in COPD Patients and Healthy Subjects: A Pilot Randomized Clinical Trial"
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External counterpulsation therapy significantly improved the exercise endurance of normal adults, low endurance adults, and COPD patients.
458:"Does Enhanced External Counterpulsation (EECP) Significantly Affect Myocardial Perfusion?: A Systematic Review & Meta-Analysis"
333:"Enhanced external counterpulsation for the treatment of stable angina and heart failure: a systematic review and economic analysis"
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Lin S, Liu M, Wu B, Hao Z, Yang J, Tao W (18 January 2012). "External counterpulsation for acute ischaemic stroke".
274:"Enhanced external counterpulsation in rehabilitation of erectile dysfunction: a narrative literature review"
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While an individual is undergoing ECP, they have pneumatic cuffs on their legs and is connected to
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McKenna C, McDaid C, Suekarran S, Hawkins N, Claxton K, Light K, et al. (April 2009).
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Amin F, Al Hajeri A, Civelek B, Fedorowicz Z, Manzer BM (17 February 2010).
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Zhao M, Huang Y, Li L, Zhou L, Wu Z, Liu Y, Zhang H, Hu C (7 January 2020).
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One theory is that ECP exposes the coronary circulation to increased
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https://epub.ub.uni-muenchen.de/12337/1/Deindl_Schaper_12337.pdf
374:"Enhanced external counterpulsation for chronic angina pectoris"
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International
Journal of Chronic Obstructive Pulmonary Disease
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Soran O, Crawford LE, Schneider VM, Feldman AM (March 1999).
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infarction, cardiogenic shock, and congestive heart failure.
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Raeissadat SA, Javadi A, Allameh F (3 December 2018).
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Illustration showing cardiac external counterpulsation
719:“Heal Your Heart with EECP” by Debra Braverman, MD.
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682:Journal of the American College of Cardiology
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517:The Cochrane Database of Systematic Reviews
456:Qin X, Deng Y, Wu D, Yu L, Huang R (2016).
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133:and deflate at the beginning of
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343:(24): iii–iv, ix–xi, 1–90.
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673:Conti, C. R. (June 1999).
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