CARING FOR THE PEOPLE OF NORTHEAST MICHIGAN

GREAT LAKES HEART CENTER OF ALPENA

Current treatment for angina, including drug therapy along with revascularization by either percutaneous transluminal coronary angioplasty or coronary artery bypass grafting (CABG), can be effective in a significant number of patients. However, the side effects of medications, coronary vasculature not amenable to either initial or repeat revascularization or diminishing treatment benefit may occur over time.

Enhanced external counterpulsation (EECP) is a noninvasive, pneumatic technique that utilizes ECG gated diastolic inflation of a series of lower-extremity cuffs to effectively increase diastolic and mean intracoronary pressures as well as coronary flow while reducing systolic pressure in the central aorta. In addition, EECP improves diastolic filling, decreases left ventricular (LV) end-diastolic pressure, and LV diastolic function. This combination of systolic unloading and increased coronary perfusion pressure with external counterpulsation mimics the hemodynamic effects of intra-aortic balloon counterpulsation. Indeed, EECP was initially evaluated in the treatment of patients with cardiogenic shock . Repeated administration of EECP has been shown to have salutary benefits in patients with symptoms of coronary artery disease and normal LV function despite optimal medical therapy; patients receiving 35 h of active counterpulsation over a 4- to 7-week period demonstrated reduced angina symptoms and extended time to exercise induced ischemia. In addition, EECP improved stress myocardial perfusion both at baseline and at maximal exercise levels, reduced plasma levels of brain natriuretic peptides.  EECP effected a significant improvement in health related quality of life up to 12 months after completion of treatment. Although the specific mechanisms responsible for the beneficial clinical effects of EECP therapy in patients with symptomatic coronary artery disease remain unclear, recent studies have demonstrated that a positive response to EECP is associated with enhanced peripheral endothelial function (2).

EECP represents the only truly noninvasive technique for which both a reduction of anginal symptoms and an improvement in objective measures of myocardial ischemia have been shown (3). Great Lakes Heart Center  was among the first in the state (and the only one in Northern Michigan) to offer EECP as a treatment modality. We reference several papers on EECP, as well as links to several other centers offering this treatment.  To refer patients for EECP evaluation call us or click here.