I have already had bypass surgery/angioplasty/stents. Can I still have EECP ?
Yes. The majority of our patients on EECP therapy have already had coronary angioplasty with stents (PCI) and/or CABG surgery. They received EECP therapy because of recurrent angina pectoris or similar symptoms despite medical therapy and/or revascularization.
How long can last the clinical effects of EECP?
The clinical benefits of EECP extend beyond the time period of any acute hemodynamic beneficial effects. For example, the patients treated with EECP in the Multicenter Study of Enhanced External Counterpulsation reported a reduction in angina episodes and decrease in nitrate use beyond the duration of therapy.
It is not fully understood why after the EECP therapy is completed, the patient remains improved and the clinical benefit can last several years.
What is the equipment of EECP consisting of?
The EECP equipment consists of:
- Air compressor
- A computer console
- A treatment table
- A set of 3 pneumatic cuffs applied to each lower extremity.
How much pressure is applied during inflation?
The pressure applied to the pneumatic cuffs during sequential inflation -from calves to thighs to buttocks- is 4 – 6 pounds per square inch (psi) which is the equivalent to 206 to 360 mmHg.
What is the mechanism of action of EECP ?
- Improve endothelial function through increase vasodilatation and decrease of intimal hyperplasia. EECP leads to improved coronary blood flow derived from increased shear stress, which leads to increased endothelial nitric oxide release and resultant vasodilatation.
- Enhance collateral capillary development by increasing blood flow to the ischemic region of the myocardium and increase capillary density. Shear stress is a known stimulus for coronary collateral development and recruitment. Vascular endothelial growth factors (VEGF) and platelet-derived growth factors (PDGF) that are crucial in angiogenesis are up regulated by vascular shear stress.
- Improve neurohormonal factors by increasing nitric oxide and decreasing B-type natriuretic peptide (BNP), atrial natriuretic peptide (ANP), and angiotensin II.
- Reduce arterial stiffness which leads to a decrease in vascular resistance and blood pressure; and an increase in cardiac efficiency.
- EECP may promote improvement in exercise duration with no change in peak double product by reduction in peripheral vascular resistance.
Is there a difference between EECP and ECP?
Yes. EECP is a registered trademark of Vasomedical, Inc., the leading manufacturer of EECP equipment in the U.S. Vasomedical has a patent on the timing mechanism of the machine (when the cuffs squeeze and release in time to the patient’s EKG, the most critical part of the treatment). This timing mechanism distinguishes them from those who make other external counterpulsation (ECP) equipment, and makes the EECP machine by far the most clinically effective device on the market. Every published U.S. study and most studies originating in countries around the world and published in the leading English-language medical journals have used the Vasomedical EECP equipment exclusively
Can a patient with atrial fibrillation have EECP therapy?
Uncontrolled atrial fibrillation, atrial flutter, and frequent PVCs may interfere with triggering of the EECP system. The average beats should be of 50-100/min. However, if the heart rate is controlled and no faster than 100 bpm, atrial fibrillation will not interfere with EECP .
Frequent and irregular heartbeats with high heart rate (HR) >100 or low HR <50 should delay EECP until rate control has been achieved.
Can a patient with varicose veins have EECP ?
Yes. Varicose veins do not preclude individuals from receiving EECP . We often use extra padding in patients with varicose veins to ensure maximum comfort. However, if the diagnosis of deep vein thrombosis is entertained, a venous US Doppler study of the lower extremities should be performed before EECP .
Can a patient with peripheral artery disease have EECP ?
Yes. EECP improves blood flow throughout the entire body, including the lower extremities. In our experience, patients with this condition –if not severe- may require more than 35 EECP sessions to obtain the full benefit of the therapy. We have documented with arterial Doppler studies the circulation of the lower extremities, before and after EECP in some patients with diabetes -with marked improvement in response to EECP .
What happens if angina returns months or years after a patient finish EECP treatment course? Can he / she come back for more?
Yes. EECP is not an once-in-a-lifetime treatment. Heart disease is a chronic inflammatory illness and symptoms may return at some point in the future. In this case, a myocardial perfusion study is performed to document reversible ischemia, and EECP therapy can be repeated sequentially with three months intervals in between according to Medicare guidelines.
Does EECP aggravate high blood pressure (hypertension)?
No. If you have hypertension that is properly managed, you may undergo EECP without difficulty. Oftentimes, patients with hypertension find that their blood pressure improves as they proceed with EECP . If your hypertension is uncontrolled, you must seek medical care to get your blood pressure under control with proper medications before proceeding with EECP .
As a matter of fact, EECP has a therapeutic role in the management of arterial hypertension and hypertensive heart disease.
Is there an age limit for EECP ?
No. We have successfully treated patients as young as 35 and as old as 86 without any difficulties. Many of our patients are in their 80s and complete the entire EECP program with excellent results.
Can EECP dislodge plaque and cause a stroke or heart attack?
No. Atherosclerotic plaques are calcified and hard, and they create an obstruction that detours the blood through alternate routes of least resistance. During EECP , when blood is flowing to your heart, it will naturally bypass arteries with significant plaque and enter healthy, non-diseased blood vessels to go around the blockages. In time, these new pathways are reinforced and become lasting routes for blood to reach your heart beyond the blockages. This is why; EECP is often called the “natural bypass.”
What happens if a patient misses an EECP session?
Missing a day of EECP therapy will not have a negative effect on the overall treatment. Just like any other therapy, you are encouraged to have EECP every day, except for weekends. The more consistent you are with the EECP schedule, the better the results will be. The missed session will be added to the end of your program until you have a total of 35 sessions.
Besides angina, does EECP have been useful for other non-cardiac conditions?
In our experience, EECP has been useful for other non-cardiac conditions such as erectile dysfunction, renal failure with fluid retention refractory to diuretics, and obesity associated with fluid retention as well.
At the present, it has been described that EECP has a therapeutic role in the treatment of restless leg syndrome, hepatorenal syndrome, erectile dysfunction, syndrome X, and retinal artery occlusion.
Why is EECP an underutilized therapy in patients with refractory AP?
Most practicing cardiologists today don’t have hands-on experience with this modality. Many of the university medical centers who train cardiology fellows don’t have an EECP program. There are some logistic problems involved as well. For example, if you live in Anaheim and there is an EECP program at Cedars Sinai Medical Center in Los Angeles, you will spend about 2-4 hours in going back and forth to this Medical Center for one hour of therapy every day for 35 days.
Lack of exposure to EECP , and the interrupted follow-up of these patients with refractory angina pectoris miss the opportunity to see how much difference EECP can make in the symptoms and quality of life of these patients. In addition, there is not a genuine interest by the academia and/or industry to support new randomized clinical trials. Finally, to make things worse, there are cardiologists who would like to see “a more solid clinical data” to continue practicing “evidence-based medicine.”
The fact remains that you can’t argue with patients getting better and improving the quality of their lives with EECP therapy -as shown in the testimonials.