Prospective Evaluation of EECP in Congestive Heart Failure: The PEECH Trial

Arthur M. Feldman, M.D., Ph.D., F.A.C.C.; C. Richard Conti, M.D., M.A.C.C.



In This Article

Recent Data

In an analysis of data in the International EECP Registry, the benefits of EECP are largely sustained for up to 2 years (Figure 4).[6] Therapy can be repeated, producing a similar effect. At a mean interval of 378 days after initial treatment, 18% of registry patients underwent repeat EECP; 70% of these patients had a decrease of one or more angina class at the end of repeat therapy.[7] Patients also had a similar decrease in nitroglycerin use following retreatment. Most of the EECP studies to date have evaluated patients with diastolic dysfunction. In early 2005, data from the International EECP Registry were analyzed to determine if EECP produces the same immediate and sustained benefits in patients with severe systolic dysfunction.[8] Data of 746 angina patients with a history of heart failure enrolled in the registry were divided into two groups: left ventricular ejection fraction (LVEF) ≤35% and LVEF >35%. Mean LVEF was 51.0 ± 10.2% in patients with diastolic dysfunction (n=391) versus 26.3 ± 6.9% in patients with systolic dysfunction (n=355). More than 90% of patients in both groups had Canadian Cardiovascular Society class III/IV angina, and both groups reported a similar number of anginal episodes and similar nitroglycerin use. After 32 hours of EECP, angina was reduced by ≥1 class in 71.9% of diastolic versus 72.2% of systolic with similar decreases in anginal episodes and nitroglycerin use. At 1 year, 78.1% of diastolic and 75.8% of systolic had less angina than pre-EECP.

Figure 4.

Two-Year Outcomes after Enhanced External Counterpulsation for Stable Angina Pectoris. This image shows quality-of-life assessment at baseline, immediately after enhanced external counterpulsation (EECP), and at 2-year follow-up in patients with chronic angina pectoris (from the International EECP Patient Registry).


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