Acute hemodynamic effects of enhanced external counterpulsation

In the United States, there are about 17.6 million patients suffer from symptomatic coronary artery disease (CAD), affecting 7.9% of adults ≥ 20 years of age.1 An estimated 10.2 million patients have angina, and 500,000 patients will develop new angina pectoris each year.1 A subset of angina patients are categorized as refractory when symptoms continue despite optimal medical therapy and revascularization. Routine daily activities become impossible without experiencing chest pain in this patient population.2 Heart failure is a most common diagnosis in Medicare patients and nearly 5 million Americans are diagnosed with heart failure and nearly 550,000 new cases are reported every year.1 Despite maximal medical therapy, many patients continue to be symptomatic and restrict their activities and anticipate a reduced life expectancy. Several non-pharmacological treatment options are available for these patients with refractory angina, including neurostimulation, enhanced external counterpulsation (EECP), transmyocardial laser revascularization, gene therapy, percutaneous in situ coronary venous arterializations, and percutaneous in situ coronary artery bypass.2 Of these options, EECP therapy is the only Food and Drng Administraftion(FDA)-approved noninvasive technique proven to reduce angina symptoms, improve objective measures of myocardial ischemia, and improve left ventricular systolic and diastolic function.3-5