The effects of enhanced external counterpulsation on myocardial perfusion in patients with stable angina: A multicenter radionuclide study

2005 ◽  
Vol 150 (5) ◽  
pp. 1066-1073 ◽  
Author(s):  
Andrew D. Michaels ◽  
Ajit Raisinghani ◽  
Ozlem Soran ◽  
Paul-Andre de Lame ◽  
Michele L. Lemaire ◽  
...  
Keyword(s):  
Myocardial Perfusion ◽  
Stable Angina ◽  
External Counterpulsation ◽  
Radionuclide Study ◽  
Enhanced External Counterpulsation

Abstract P369: Impact of Enhanced External Counterpulsation on Exercise Duration in Patients With Chronic Stable Angina: A Meta-analysis

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Sachin A Shah ◽  
Bradley R Williams ◽  
Atiera Andrews-Pestana
Keyword(s):  
Publication Bias ◽  
Stable Angina ◽  
Visual Inspection ◽  
Chronic Stable Angina ◽  
Exercise Duration ◽  
External Counterpulsation ◽  
Bruce Protocol ◽  
Funnel Plots ◽  
The Impact ◽  
Enhanced External Counterpulsation

Introduction: Enhanced External Counterpulsation (EECP) is a non-invasive Food and Drug Administration approved treatment for patients with chronic stable angina and heart failure. Typical treatment regimen comprises of 35, 1-hour sessions of synchronized compressions of the calf, thigh, and sacral muscles over a seven-week period. Exercise duration measured using an exercise tolerance test is a commonly utilized marker of worsening ischemic disease and is predictive of cardiovascular mortality. Several studies have evaluated the impact of EECP on exercise duration with conflicting results. We sought to determine the magnitude of benefit of EECP on exercise duration. Methods: A literature search was performed in MEDLINE, CINAHL, and the Cochrane database along with hand searching of relevant articles limited to those published in the English language. Studies were included for analyses if assessing patients with stable angina and reporting exercise duration data using either the Bruce or modified Bruce exercise treadmill test. Appropriate data were extracted at baseline and after completion of the full course of EECP. Studies were excluded if presenting duplicate data or using a non-Bruce protocol. A weighted mean difference from baseline along with 95% confidence interval was calculated using the DerSimonian-Laird random-effects model. Sub-group analyses, the Cochran Q statistic, and JADAD scores were utilized to assess for heterogeneity, non-combinability, and quality of published studies respectively. Publication bias was assessed using visual inspection of funnel plots and the Egger bias statistic. Results: Our search strategy identified 1117 independent studies of which 15 were included for analyses. A total of 484 individual subjects were incorporated in the primary analysis. Exercise duration improved by 55.5 seconds (95%CI 36.1 to 74.9; Cochran Q, p=0.246) from baseline. The benefits were maintained when using a fixed-effects model, excluding small studies and limiting to studies using the Bruce protocol only. While the Egger statistic showed a lack of publication bias (p=0.121), it cannot be ruled out based on visual inspection of funnel plots. Conclusion: EECP significantly increases exercise duration by 56 seconds in patients with chronic stable angina. Further studies are needed to determine the impact of EECP on long-term outcomes. The views expressed in this material are those of the authors, and do not reflect the official policy or position of the U.S. Government, the Department of Defense or the Department of the Air Force.

Frequency and efficacy of repeat enhanced external counterpulsation for stable angina pectoris (from the International EECP Patient Registry)

2005 ◽  
Vol 95 (3) ◽  
pp. 394-397 ◽  
Author(s):  
Andrew D. Michaels ◽  
Gregory W. Barsness ◽  
Ozlem Soran ◽  
Sheryl F. Kelsey ◽  
Elizabeth D. Kennard ◽  
...  
Keyword(s):  
Angina Pectoris ◽  
Stable Angina ◽  
Patient Registry ◽  
Stable Angina Pectoris ◽  
External Counterpulsation ◽  
Enhanced External Counterpulsation

Abstract P100: Enhanced External Counterpulsation Reduces Central Blood Pressure In Stable Angina Patients: A Meta Analysis

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Elizabeth Lindemann ◽  
Kevin Pham ◽  
Gautam Kedia ◽  
Ananth Prasad ◽  
Sachin A Shah
Keyword(s):  
Blood Pressure ◽  
Arterial Stiffness ◽  
Systolic Blood Pressure ◽  
Stable Angina ◽  
Augmentation Index ◽  
Meta Analysis ◽  
Central Hemodynamics ◽  
External Counterpulsation ◽  
Before And After ◽  
Enhanced External Counterpulsation

Introduction: Emerging evidence suggests central systolic blood pressure (cSBP) and augmentation index are superior predictors of adverse cardiovascular outcomes as compared to peripheral systolic blood pressure (pSBP). Enhanced external counterpulsation (EECP) is a non-invasive treatment modality approved for the management of refractory angina. The degree of benefit from EECP on central hemodynamics and arterial stiffness remains unknown. This meta-analysis evaluated the effect of EECP on peripheral (office) blood pressure and central hemodynamic parameters. Methods: A comprehensive literature search was conducted in Pubmed, CINAHL, and Cochrane Library databases. All prospective clinical trials assessing the impact of EECP in patients with stable angina and CAD were included. Studies were excluded for not completing a full course of EECP, having a baseline peripheral systolic blood pressure &lt100 mmHg, or not reporting adequate data for analysis. The primary endpoint was the change in cSBP before and after EECP. The change in pSBP, pDBP, cDBP, and augmentation index before and after EECP were also assessed. The weighted mean difference using the DerSimonian and Laird random-effect model was utilized for determining the change in each parameter before and after EECP. Statistical heterogeneity was evaluated using the Egger’s bias statistic. Results: Five studies containing 137 unique patients were included for the cSBP analysis. cSBP was reduced significantly by -7.56 mmHg (95% CI -11.83 to -3.28; Cochrane Q=1.81) post-EECP. In the same set of studies, pSBP was reduced significantly by -9.65 mmHg (95% CI -14.32 to -4.98) post-EECP. pDBP [-4.67 mmHg (95% CI -8.56 to -0.77)] was reduced post-EECP, while no changes were evident in cDBP. Augmentation index was reduced by -3.74% (95% CI -7.05 to -0.43) post-EECP. Two studies included a sham-EECP intervention arm and demonstrated no significant changes in cSBP [0.67 mmHg (95% CI -5.66 to 7.01)] or other parameters. Conclusion: EECP significantly reduced cSBP and pSBP by approximately 8 mmHg and 10 mmHg respectively. EECP also demonstrated a mild improvement in arterial stiffness, which translates to reduced wasted left ventricular energy and myocardial oxygen demand. In patients with stable angina and CAD, EECP exerts beneficial effects in both peripheral and central hemodynamics but whether these benefits are sustained over a longer duration need further exploration.

Abstract 14036: Enhanced External Counterpulsation Reduces Blood Pressure in Patients With Chronic Stable Angina: A Meta-Analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Bradley Williams ◽  
Mehak Aggarwal ◽  
Cole Kiser ◽  
Krishnaswami Vijayaraghavan ◽  
Sachin A Shah
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Publication Bias ◽  
Stable Angina ◽  
Meta Analysis ◽  
Chronic Stable Angina ◽  
External Counterpulsation ◽  
Statistical Heterogeneity ◽  
The Impact ◽  
Enhanced External Counterpulsation

Background: Hypertension is a modifiable risk factor for ASCVD. Enhanced External Counterpulsation (EECP ® ) is an FDA-approved, non-invasive treatment modality for patients with angina and symptoms of ischemic heart failure. Various studies have demonstrated hemodynamic changes with EECP ® therapy, but the true magnitude of benefit remains unknown. We conducted a meta-analysis to assess the change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) post- EECP ® therapy. Methods: A literature search across multiple databases was conducted from its inception to March 2020. Studies evaluating the impact of EECP ® in chronic stable angina patients that reported systolic and diastolic blood pressures were extracted. Human studies published in English, where patients completed 35 hours of EECP ® (administered as 1-hour sessions) were included for analysis. Studies that reported data in multiple arms were treated as individual studies. The weighted mean difference from baseline for SBP and DBP was calculated using the DerSimonian-Laird random-effects model. Statistical heterogeneity was assessed by the I 2 statistic with publication bias evaluated using the Egger bias statistic. Subgroup analyses were performed to assess for clinical heterogeneity. Results: We identified 272 articles, of which 15 unique studies (n=659) reporting data on systolic and diastolic blood pressure were included. Post- EECP ® treatment, SBP decreased by 8.9 mmHg (95% CI 4.0 to 13.7 mmHg, I 2 =87.3%) and DBP reduced by 3.6 mmHg (95% CI 2.1 to 5.0 mmHg, I 2 =38.9%). Patients with a baseline SBP 130 mmHg appear to derive greater benefit (SBP reduced by 13.0 mmHg, 95% CI 8.3 to 17.6, I 2 =70.4%) compared to patients with a baseline SBP<130 (SBP reduced by 3.2 mmHg, 95% CI 0.4 to 6.0, I 2 =25.2). The Egger bias statistic showed no publication bias for the primary endpoints (both p-values>0.33). Conclusion: EECP ® treatment reduced SBP and DBP by over 8 and 3 mmHg respectively. The pleiotropic benefits from EECP ® provide additional hypertension control in patients with chronic stable angina.

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