EECP has been approved by US-FDA (USA), NHS (UK), CE-mark certification (Europe), American Heart Association (AHA) and American Collage of Cardiology Foundation (ACCF) for the treatment of Ischemic Heart Disease and Heart Failure.
Mechanism of Treatment
Progressive angiogenesis leading to development of collaterals
- Improvement in endothelial function
- Anti-inflammatory effect
- Release of vasodilator peptides
It is a non-invasive, outpatient therapy consisting of electrocardiography (ECG) gated sequential leg—thigh—buttock compressions which produces hemodynamic effects similar to those of an intra-aortic balloon pump (IABP).
EECP therapy consists of a treatment bed attached to an air compressor unit which is attached to a computerized control console. Three sets of cuffs wrapped around the lower legs, thighs & buttocks of the patient which inflate rapidly and sequentially at an interval of 0.4 seconds starting from the calves—thighs—buttocks during the relaxation phase of heart beat (Diastole). This creats a strong retrograde counter pulse (Pressure as high as 220-300 mm Hg) in the arterial system, forcing freshly oxygenated blood to the coronary arteries and in the venous system, increasing the venous blood return. Just before the next heart-beat (Systole), all three cuffs deflate simultaneously, reducing the heart's after-workload by significantly lowered resistance to blood ejected by the heart in the relatively empty vascular beds in the lower extremities.
Duration of Treatment
35 sittings administered 1 hour per sitting, which can be given :-
- 5 days a week for 7 weeks or
- 6 days a week for 6 weeks or
- 7 days a week for 5 weeks or
- Twice a day for 18 days
It can be given at any age, even after 100 years of age.
EECP is a non-invasive & outpatient therapy, beneficial in relieving Angina pain in almost 80% patients not responding to maximal medical treatment and is advised in :-
- Patients who have previous invasive revascularization treatment like Angioplasty-Stent & / or Bypass surgery being failed due to stenosis of stents or blockage in bypass grafts.
- Patients who are not fit for invasive / surgical procedures because of unsuitable coronary anatomical effects like diffuse coronary sclerosis.
- Patients who are not fit for Angioplasty-Stent & / or Bypass surgery because of associated advanced extra-cardiac diseases like Renal failure, Hepatic failure or Pulmonary failure.
- Patients who are not willing for any surgical intervention because of their own wish or financial constraints.
- Patient who are not fit for invasive / surgical procedures due to advanced age.
Deep Vein Thrombosis
- Major Fractures of Spine & Legs
The benefits of EECP therapy are documented by :-
Improvement in Symptoms
Decrease in episodes & intensity of anginal pain
- Increase in work capacity in walking, climbing upstairs
- Betterment in overall wellbeing & sleep pattern
Improvement in Stress Thallium/ CTMT/ Echocardiography
Increase in Myocardial perfusion;
Increase in Exercise duration (METS)
- Increase in Ejection Fraction (EF)
EECP in Extra-cardiac Diseases
EECP increases blood supply to all vital organs like Heart (20-42%), Brain (22-26%) & Kidneys (19-20%), that's why it is not only effective in heart attack but also beneficial in :-
Paralysis (Ischemic Stroke)
- Dementia (multi-infarct)
- Parkinson's disease
- Renal Vascular diseases
- Avascular Necrosis of Femur Head
- Sudden blindness (Retinal Artery Blockage)
EECP in Prevention of Heart Attack
EECP therapy is advised before bypass surgery to improve the myocardial function so as to decrease operative & post-operative complications, morbidity and mortality. On the other hand, it is also advised in post-angioplasty & post-CABG patients so as to avoid early stenosis of stents and blockages in bypass grafts.
The chances of heart attack increases by many folds in persons carrying two or more risk factors like Diabetes, Hypertension, Dyslipidemia, Obesity, Tobacco users or Stress. Preventive EECP Therapy in this population can minimize the incidenc & intensity of heart attacks.