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J Am Coll Cardiol. 2001 Jan;37(1):93-9.

Enhanced external counterpulsation improves exercise tolerance, reduces exercise-induced myocardial ischemia and improves left ventricular diastolic filling in patients with coronary artery disease.

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Department of Internal Medicine III, Kurume University School of Medicine, Japan.



We examined whether enhanced external counterpulsation (EECP) improves myocardial ischemia, exercise tolerance and cardiac function in patients with coronary artery disease (CAD).


Enhanced external counterpulsation reduces angina and improves exercise tolerance in patients with CAD. Some objective improvements of ischemia by EECP have been reported, but they should be confirmed further. Detailed hemodynamic effects of EECP have been less well documented.


Enhanced external counterpulsation was performed for a total of 35 h in patients with stable CAD (n = 12) who showed evidence of exercise-induced myocardial ischemia despite conventional medical or surgical therapies. All patients had significant stenotic lesions in major coronary arteries.


Enhanced external counterpulsation improved all exercise test parameters (p < 0.05): exercise duration, time to 1-mm ST segment depression, rate-pressure product at peak exercise and rate-pressure product at 1-mm ST segment depression. Moreover, the prevalence of exercise-induced reversible perfusion defects by thallium scintigraphy decreased after treatment (p < 0.01). Enhanced external counterpulsation did not alter systolic function but improved diastolic filling, left ventricular (LV) end-diastolic pressure (p < 0.05) by cardiac catheterization and LV peak filling rate end-diastolic volume/s (p < 0.01) and time to peak filling rate (p < 0.05) by radionuclide scintigraphy. These hemodynamic improvements were associated with decreased plasma brain natriuretic peptides levels after EECP (p < 0.05).


Thus, EECP treatment improves exercise tolerance and reduced myocardial ischemia by thallium scintigraphy in association with improved LV diastolic filling in patients with stable CAD.

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