Enhanced External Counterpulsation (EECP) in Refractory Angina Pectoris; Six Months Follow- Up
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Enhanced External Counterpulsation (EECP) in Refractory Angina Pectoris; Six Months Follow- Up,ABDELMAKSOUD A. EL GANADY, DINA Y. NASSAR, AHMAD M. IBRAHIM, MOHAMED H. ALLAM, AHMAD A. EMAM, GAMAL A. EL-ATTAR and SALAMA H. OMAR
Abstract
Introduction: Enhanced External Counterpulsation (EECP) is a new non-invasive procedure that is used a therapeutic option for ischemic patients who are not eligible for other therapeutic options.
Objectives: The aim of the present study was to evaluate the immediate and 6 months response to EECP sessions in patients with chronic refractory angina where no other options for surgical or percutaneous revascularization procedures are left.
Methods: 48 patients (15 Females, 33 Males) were treated by EECP. All patients were subjected to 35 sessions over 7 weeks (5days/week). Each session lasted for one hour. We looked at Canadian cardiac society class (CCS) nitroglycerine use per week and echocardiographic analysis (EF and SWMA) and adverse events where evaluated prior to EECP, at the end of study and six month later. And the results where compared.
Results: 73% of the patients responded by improving one CCS class and 10% by more than 2 CCS class. 83% of those patients showed sustained improvement over 6 months. The mean nitroglycerin weeldy consumption significantly decreased from 8.25 tablets/week to 3.12 tablets/week immediately and continued decreasing even after 6 months. p-value=0.003. Segmental wall motion abnormality significantly improved. In 40% of the patients there was an improvement of 3 or more segments in the immediate phase, this improvement was maintained at the end of 6 months at 90% of the cases. The mean EF improved from 35.8% to 39.3% in the immediate phase and 38% at 6 months. The therapy was discontinued in two patients.
Conclusion: EECP is a non invasive procedure that can reduce the symptoms of Ischemic heart disease like Angina and heart failure. It improves both (CCS) and New York Heart Association (NYHA) classifications, decreases in weekly angina episodes and nitroglycerin use. It improves SWMA, EF and Pro-BNP as a marker of LV dysfunction was significantly decreased. The study confirms the safety and efficacy of EECP in patients with refractory angina when other options are not available.