Safety and Future Directions of ECP Therapy

Abstract

In 1998, the International EECP Patient Registry (IEPR) was organized to document patient characteristics, safety, and efficacy during the treatment period, as well aslong term outcomes. All centers with EECP facilities were invited to join this voluntary registry. The registry population comprises all patients starting EECP for treatment of angina pectoris in participating centers. It is crucial to monitor treatment efficacy during EECP sessions. Parameters are adjusted accordingly to ensure optimal benefit. Different conditions require different data points to be monitored. Indices for immediate hemodynamic effects are inflation/deflation time, inflation pressure, ECG, blood pressure, D/S ratio and DP/SP ratio, and in some cases, stroke volume, cardiac output, myocardial contractility, cardiac preload, peripheral vascular resistance. The American Heart Association recommends it as a Class IIb (Level of Evidence: B) intervention for treatment of RAP, among other nonpharmacological approaches such as Neurostimulation (Class IIb, Level of Evidence: B) and Transmyocardial laser revascularization (Class IIa, Level of Evidence: A). The European Society of Cardiology views EECP therapy as an interesting modality available for treatment of RAP with more clinical trials needed to define its role in treating RAP.  Enhanced external counter pulsation therapy is a valuable outpatient procedure providing acute and long-term relief of anginal symptoms and improved quality of life among a group of patients with symptomatic ischemic heart disease with or without congestive HF. Enhanced external counter pulsation therapy is generally well tolerated. Due to the vigorous compression applied to the lower extremities, certain factors may theoretically pre dispose patients to complications, including a bleeding diathesis, severe valvular disease, uncompensated heart failure with significant peripheral edema or pulmonary hypertension, or a high likelihood of venous thrombotic disease.