External Counterpulsation (ECP) Therapy as an Effective Treatment among Patients with Heart Failure undergoing Cardiac Rehabilitation

Background: External counterpulsation (ECP) is a noninvasive procedure using lower limbs pressure cuffs to improvecoronary artery blood flow and offload the heart. There is currently no data on the effects of ECP among patients undergoingcardiac rehabilitation (CR). This pilot study aims to determine whether ECP improves exercise capacity among patients withheart failure or post acute myocardial infarction undergoing cardiac rehabilitation.Methods: This is a prospective randomised-controlled pilot study of the effect of ECP in patients with mild to moderateheart failure or post-acute myocardial infarction undergoing CR. Eligible patients were randomised at ratio of 1:1 to eithercombination of CR and ECP or CR only. All subjects received up to 16 sessions of conventional CR. For the combination arm,subjects received up to 16 one-hour sessions of one-hour ECP therapy following each CR session. All underwent baselinecardiopulmonary testing (CPET) and NT-Pro BNP determination and after completion of study.Results: A total of 4 patients were enrolled in the study from June 2016 to Jan 2017. Two were randomised to combinationarm and two into CR arm. Post treatment VO2MAX improved 12 % in the combination arm (23.3±5.6 ml/min/kg from20.8±5.3ml/min/kgat baseline) compare to 5% in the CR arm (23.0±6.2 ml/min/kg from21.9±2.3 ml/min/kg at baseline). There were nosignificant difference in the post treatment VO2MAX between groups, p=0.97. There was a 16% increased in post treatmentmaximum oxygen pulsein the combination group (14.4±1.0ml/beat from12.4±0.5ml/beat at baseline) compare to a 7.8%increased in the CR group (12.4±2.2ml/beat from11.5±1.4ml/beat at baseline). Interestingly, NT proBNP level worsenedpost treatment in the combination group (447.5±563.6 pre treatment to 472.7±560.5 post treatment), whereas improved inthe CR only group (950.5±522.9 pre treatment to 327.5±202.6 post treatment).Conclusion: Cardiac Rehabilitation is known to improve exercise capacity among heart failure patients. ECP can furtherenhanced maximum oxygen consumption and maximum oxygen pulse in patients with mild to moderate degree of heartfailure or post myocardial infarction undergoing cardiac rehabilitation. More studies with larger numbers are needed toprove this benefit of ECP.