Enhanced External Counterpulsation Improves Exercise Tolerance in Patients With Chronic Heart Failure

• Published in: Journal of the American College of Cardiology 2006-09, Vol.48 (6), p.1198-1205
• Main Authors: Feldman, Arthur M., Silver, Marc A., Francis, Gary S., Abbottsmith, Charles W., Fleishman, Bruce L., Soran, Ozlem, de Lame, Paul-Andre, Varricchione, Thomas
• Format: Article
• Language: English
• Subjects: Aged; Angina pectoris; Cardiology; Chronic Disease; Coronary vessels; Counterpulsation - methods; Drug therapy; Exercise Tolerance; Female; Heart attacks; Heart Failure - drug therapy; Heart Failure - physiopathology; Heart Failure - therapy; Humans; Male; Middle Aged; Prospective Studies; Severity of Illness Index
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2005.10.079

Enhanced External Counterpulsation Improves Exercise Tolerance in Patients With Chronic Heart Failure Arthur M. Feldman, Marc A. Silver, Gary S. Francis, Charles W. Abbottsmith, Bruce L. Fleishman, Ozlem Soran, Paul-Andre de Lame, Thomas Varricchione, for the PEECH Investigators The PEECH (Prospective Evaluation of Enhanced External Counterpulsation in Congestive Heart Failure) trial assessed the benefits of enhanced external counterpulsation (EECP) in patients with mild-to-moderate heart failure (HF) receiving protocol-defined pharmacologic therapy. Addition of EECP to pharmacologic therapy significantly improved exercise duration in these patients during a 6-month follow-up. However, there was no between-group difference in peak Vo2changes at 6 months. Thus, EECP effected significant improvements in functional capacity and quality of life without a change in peak Vo2. The PEECH (Prospective Evaluation of Enhanced External Counterpulsation in Congestive Heart Failure) study assessed the benefits of enhanced external counterpulsation (EECP) in the treatment of patients with mild-to-moderate heart failure (HF). Enhanced external counterpulsation reduced angina symptoms and extended time to exercise-induced ischemia in patients with coronary artery disease, angina, and normal left ventricular function. A small pilot study and registry analysis suggested benefits in patients with HF. We randomized 187 subjects with mild-to-moderate symptoms of HF to either EECP and protocol-defined pharmacologic therapy (PT) or PT alone. Two co-primary end points were pre-defined: the percentage of subjects with a 60 s or more increase in exercise duration and the percentage of subjects with at least 1.25 ml/min/kg increase in peak volume of oxygen uptake (Vo2) at 6 months. By the primary intent-to-treat analysis, 35% of subjects in the EECP group and 25% of control subjects increased exercise time by at least 60 s (p = 0.016) at 6 months. However, there was no between-group difference in peak Vo2changes. New York Heart Association (NYHA) functional class improved in the active treatment group at 1 week (p < 0.01), 3months (p < 0.02), and 6 months (p < 0.01). The Minnesota Living with Heart Failure score improved significantly 1 week (p < 0.02) and 3 months after treatment (p = 0.01). In this randomized, single-blinded study, EECP improved exercise tolerance, quality of life, and NYHA functional classification without an accompanying increase in peak Vo2.