American College of Cardiology

New Technique Found to Help Angina Patients

(Jun. 1, 1999) Angina patients who experience chest pain despite drug therapy and/or revascularization procedures benefit from a new procedure called enhanced external counterpulsation (EECP), according to a new study appearing in the June issue of the Journal of the American College of Cardiology.

Patients undergoing EECP lie on a table and wear a kind of pressure suit that covers their legs. At the moment of every heartbeat when the heart relaxes, the suit rapidly and briefly inflates, causing a significant increase in the return of blood to the heart. With each inflation the device reduces the immediate workload of the heart and helps increase its pumping efficiency. EECP therapy usually consists of one hour per day for 35 days and is generally well tolerated by patients.

The clinical effects of EECP were tested in 139 angina patients in the Multicenter Study of Enhanced Counterpulsation (MUST-EECP). Patients in the study underwent active treatment or inactive treatment. Patients in the inactive arm underwent the same type of treatments as patients in the active arm, but the pressure of the device was not strong enough to affect blood flow. Neither the patients nor the doctors who assessed them knew whether they were receiving active treatment; though by necessity, the technicians who administered the treatments were aware of treatment assignment.

After undergoing 35 hours of treatment, patients who received active treatment had fewer episodes of angina and were able to exercise longer without provoking abnormal electrocardiogram (ECG) changes than patients who underwent inactive treatment. Patients who underwent active treatment also required less nitroglycerin.

"The precise mechanism by which EECP exerts its long-term beneficial effect is unknown," said Dr. Richard W. Nesto, of the Harvard Medical School in Boston. "This will open up some new scientific areas of major interest." He speculated that the benefits of EECP are probably related to improvement in the function of the endothelium, the vital cells that line the inner walls of blood vessels and help regulate their function. "Another potential mechanism could be the recruitment of collateral coronary vessels," he said.

In a related editorial, Dr. C. Richard Conti, of the University of Florida at Gainesville, wrote that EECP has "great potential and could be particularly applicable to patients who are not candidates for revascularization procedures like bypass surgery or balloon angioplasty, but who continue to have angina episodes." Dr. Conti said that he was looking forward to using EECP in his own clinical practice in the very near future.

The American College of Cardiology, a 24,000-member nonprofit professional medical society and teaching institution, is dedicated to fostering optimal cardiovascular care and disease prevention through professional education, promotion of research, leadership in the development of standards and guidelines, and the formulation of health care policy.

The American College of Cardiology (ACC) provides these news reports of clinical studies published in the Journal of the American College of Cardiology as a service to physicians, the media, the public, and other interested parties. However, statements or opinions expressed in these reports reflect the view of the author(s) and do not represent official policy of the ACC unless stated so.

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