Enhanced external counterpulsation ( EECP ) is a non-surgical method for the treatment of coronary heart disease (CHD). It allows to improve coronary blood flow by counterpulsation with special air cuffs on the legs during the diastole phase of the heart, enhancing the physiological filling of coronary blood vessels. At the time of systole, air is abruptly pumped out of the cuffs, which reduces the overall vascular resistance and stress on the heart. After the course of procedures, the functional state of patients with coronary artery disease improves, the functional class of angina pectoris decreases, and stress test indicators improve [1] [2] [3] .
Recommended by the All-Russian Scientific Society of Cardiology (GFCF), the Russian National Society of Heart Failure Specialists (AHCH), the American College of Cardiology (ACC), and other professional medical communities. In Russia (EECP) successfully tested by volunteers at the State Research Institute of Military Medicine of the Moscow Region .
After conducting a successful large study at Stony Brook University, NY, as well as a clinical study of the MUST-EECP method, it became widely used in the United States. Now the method is widely used in Russian clinics and medical centers .
Content
Methodology
The impact is created by crimping the limbs using cuffs. The cuffs of the legs, hips and buttocks are inflated sequentially under high pressure with air, creating a wave of blood pressure in the arteries. The commencement of compression is regulated by monitoring the ECG relative to the cardiac cycle so that the pressure wave retrogradely reaches the aortic arch at the time of diastole. This leads to an increase in pressure at the mouth of the aorta and an increase in blood flow through the coronary vessels. There is an increase in venous return to the right heart, which theoretically can increase the ejection by the Frank-Starling mechanism . Instantly pumping air out of the cuffs at the onset of ventricular contraction reduces vascular resistance and decreases heart function.
When EECP is performed, blood contact with the actuator is excluded, and its hemodynamic effect is comparable to the effect of balloon intra-aortic counterpulsation. EECP is the only non-invasive technique that provides reduction of angina attacks and objective signs of myocardial ischemia.
The simplest mechanism by which EECP can enhance collateral perfusion is to open previously formed collateral channels, or directly through the release of vasodilating substances such as NO.
The method is recommended as an additional treatment for chronic heart failure of FC II — III during the period of complete compensation for optimal drug therapy (recommendation class IIb). With angina pectoris I-IV FC, including resistant to conservative therapy. The application of the method of enhanced external counterpulsation increases resistance to physical exertion.
EECP is an outpatient procedure, a long-term reduction in the symptoms of angina pectoris in a group of patients with coronary artery disease. The data obtained show that EECP acts through various mechanisms, including improving endothelial function, stimulating the development of collaterals, enhancing the function of the left ventricle and the effects that are observed with constant physical activity.
Indications
- Angina pectoris I-IV functional class, including drug-resistant.
- Relapse of angina pectoris after a coronary artery bypass grafting , stenting .
- Obliterating atherosclerosis of the peripheral arteries.
- Arterial hypertension .
- Cerebrovascular ischemic diseases ( ischemic stroke , transient disturbances in cerebral circulation , vertebrobasilar ischemia ).
- Coronary diseases of the eye ( thrombosis of the central artery of the retina , ischemic damage to the optic nerve , chorioretinopathy , retinitis ).
- Erectile dysfunction of vascular origin.
- Increased exercise tolerance in athletes.
Contraindications
Heart failure is higher than FC II according to NYHA or NK higher than IIA degree (during the NKP procedure, venous return increases, which can lead to pulmonary edema).
Aortic valve insufficiency is higher than grade I, since increased diastolic pressure increases LV regurgitation. A history of phlebitis and / or thrombophlebitis (mechanical compression of the lower extremities can lead to thromboembolism).
Notes
- ↑ Zheng ZS, LiTM, Kambic H., et al. Sequential external counterpulsation (SECP) in China (English) // Trans Am Soc Artif Intern Organs : journal. - 1983. - Vol. 29 . - P. 599-603 . - PMID 6673295 .
- ↑ Arora RR, Chou TM, Jain D., et al. The multicenter study of enhanced external counterpulsation (MUST-EECP): effect of ECP on exercise-induced myocardial ischemia and anginal episodes // J. Am. Coll. Cardiol. : journal. - 1999 .-- June ( vol. 33 , no. 7 ). - P. 1833-1840 . - DOI : 10.1016 / S0735-1097 (99) 00140-0 . - PMID 10362181 .
- ↑ Lawson WE, Hui JC, Zheng ZS, et al. Improved exercise tolerance following enhanced external counterpulsation: cardiac or peripheral effect? (English) // Cardiology: journal. - 1996. - Vol. 87 , no. 4 . - P. 271-275 . - DOI : 10.1159 / 000177103 . - PMID 8793157 .
Literature
- American Heart Association. 2002 Heart and Stroke Statistical Update. Dallas, TX: American Heart Association, 2001.
- Kim MC, Kini A, Sharma SK. Refractory angina pectoris: mechanism and therapeutic options. J Am Coil Cardiol 2002; 39: 923-34.
Links
- Sudarev A.M., Isaev I.A., Kantor P.S., Korotich E.V. Technical implementation of the external counterpulsation apparatus . Institute of Radio Engineering and Electronics, RAS, CONSTEL Limited Liability Company.
- Chance for the doomed (inaccessible link) . TOMSK VESTNIK, 03/25/2006