Enhanced external counterpulsation for ischemic heart disease

What's behind the curtain?

Piero O. Bonetti, David Holmes, Amir Lerman, Gregory W. Barsness

Research output: Contribution to journalArticle

100 Citations (Scopus)

Abstract

Enhanced external counterpulsation (EECP) has been shown to reduce angina and to improve objective measures of myocardial ischemia in patients with refractory angina. Prospective clinical studies and large treatment registries suggest that a course of EECP is associated with prolongation of the time to exercise-induced ST-segment depression and resolution of myocardial perfusion defects, as well as with enhanced exercise tolerance and quality of life. With a growing knowledge base supporting the safety and beneficial clinical effects associated with EECP, this therapy can be considered a valuable treatment option, particularly in patients who have exhausted traditional revascularization methods and yet remain symptomatic despite optimal medical care. However, although the concept of external counterpulsation was introduced almost four decades ago, and despite growing evidence supporting the clinical benefit and safety of this therapeutic modality, little is firmly established regarding the mechanisms responsible for the beneficial effects associated with this technique. Suggested mechanisms contributing to the clinical benefit of EECP include improvement in endothelial function, promotion of coronary collateralization, enhancement of ventricular function, peripheral effects similar to those observed with regular physical exercise, and nonspecific placebo effects. This review summarizes the current evidence for a contribution of these mechanisms to the clinical benefit associated with EECP.

Original languageEnglish (US)
Pages (from-to)1918-1925
Number of pages8
JournalJournal of the American College of Cardiology
Volume41
Issue number11
DOIs
StatePublished - Jun 4 2003

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Counterpulsation
Myocardial Ischemia
Exercise
Safety
Placebo Effect
Exercise Tolerance
Knowledge Bases
Ventricular Function
Therapeutics
Registries
Perfusion
Quality of Life
Prospective Studies

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Enhanced external counterpulsation for ischemic heart disease : What's behind the curtain? / Bonetti, Piero O.; Holmes, David; Lerman, Amir; Barsness, Gregory W.

In: Journal of the American College of Cardiology, Vol. 41, No. 11, 04.06.2003, p. 1918-1925.

Research output: Contribution to journalArticle

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