ABSTRACT
Background: The purpose of this study was finding relationship between the therapeutic effects of Enhanced External Counterpulsation on treatment resistant angina among the patients, who are unsuitable for invasive interventions. Aims & Objective: To study the therapeutic effects of Enhanced External Counter Pulsation (EECP) on clinical symptoms, echocardiographic measurements, perfusion scan parameters and exercise tolerance test in coronary artery disease patients with refractory angina. Material and Methods: In an interventional study 50 patients (34 men and 16 women) under EECP therapy were investigated for one year. This machine is composed of three pairs of cuffs which work by attaching cuffs to lower limbs and it is contracted during diastole from distal to proximal and makes pressure to vessels of lower limbs. Treatment effects of EECP on clinical signs were evaluated on the base of Canadian cardiovascular society classification for angina severity, drugs consumption and SF36 quality of life questionnaire. Para clinical assessments including echocardiography, perfusions scan and exercise tolerance test parameters were also assessed prior to EECP, at the end of the treatment and at 12 months thereafter. Any differences in background measurements were recorded and analyzed. Results: Decrement of angina severity and improvement of life quality before and after one month EECP therapy was significant (p<0.001, p=0.01). The rate of nitrate consumption and other medications causes no significant difference concerning dosage decrease (p>0.05). There was significant difference between ejection fraction of before, one month and one year after treatment only in severe IHD (p=0.016, p=0.038, respectively). Left ventricle end diastolic and end systolic diameters were also significantly decreased after one month (p= 0.031), and this improvement remained up to one year. Difference between ischemia severity in perfusion scan before and one month afterwards was significant as well (p= 0.044). The exercise tolerance test duration after one month also increased (p<0.001) and did not change statistically after one year. Conclusion: This study demonstrated that EECP is a useful method, while effective and safe for patients with severe refractory angina pectoris resistant to drug therapy and aggressive interventions such as PCI or CABG are not suitable.