Gregory W Barsness, MD

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EECP Pushing forward

• Gregory W Barsness, MD
• Director, EECP Program
• Mayo Clinic
• Rochester, MN

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EECPPushing forward
The process

• Cuffs inflate sequentially to milk blood up to
  the heart in diastole.
• (click to view animation)

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EECPPushing forward
Indications/contraindications

• INDICATIONS
• Symptomatic ischemic coronary disease
• CONTRAINDICATIONS
• Aortic insufficiency
• Severe valvular disease
• Cardiac catheterization lt2 weeks
• Arrhythmia
• Severe hypertension (gt180/110mmhg)
• History of DVT

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EECPPushing forward
Pilot study
8 patients received 35 separate EECPsessions,
each lasting for 1 h, over 7 weeks
Pre-EECP Post-EECP
Mean PAMP (mW/cm4) 4.2 1.6 5.4 2.0
Mean EF 25 10 29 8
Mean heart rate (min-1) 73 5 65 5
preload-adjust maximal power preload-adjust maximal power preload-adjust maximal power
Dr John Gorcsan, 49th Annual Scientific Session
of the American College of Cardiology
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EECPPushing forward
MUST-EECP
139 patients randomized to either active or
inactive EECP (double-blind)
Change post-treatment Exercise duration (s) Time to ST depression (s)
Inactive EECP 32 (p lt0.03) 4 (p lt0.74)
Active EECP 44 (p lt.001) 42 (p lt.002)
Between-group p value lt0.31 0.01

Arora RR, et.al. J Am Coll Cardiol 1999
331833-1840
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EECPPushing forward
Whats next

• Congestive Heart Failure study
• Approved Sept 6, 2000 by the FDA
• 180 patients in 18 centers across the US

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EECPPushing forward
Mechanism

• Exact mechanism unknown, but possibilities
  include
• 1) collateral development provoked through
  increased expression of growth factors
• 2) Passive exercise (blood pressure
  modification, sympathetic and neurohormonal
  changes)

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EECPPushing forward
Hurdles to acceptance

• Its a difficult therapy to watch. Its a lot of
  motion, its an aggressive diastolic milking of
  the blood centrally. On the table, patients are
  bouncing around and its a little uncomfortable
  for the patients to start. Its not painful at
  all, but its a little uncomfortable.
• Gregory W Barsness, MD
• Director, EECP Program
• Mayo Clinic
• Rochester, MN

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EECPPushing forward
When to use ECP

• Should be used in patients unable to be
  revascularized a second time and those in whom
  medical therapy has failed.
• Avoid using in patients with active deep venous
  thrombosis.
• Doesnt work well in people with claudication.
• Approximately 10 of patients cannot tolerate
  EECP therapy, due to leg or back pain, or leg and
  skin abrasions caused by the leg cuffs.

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EECPPushing forward
Long term follow up

• International EECP Patient Registry
• (University of Pittsburgh Graduate School of
  Public Health)
• 2800 patients
• 3300 cases
• Intends to track 5000 patients with 3 year
  follow-up.

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EECPPushing forward
Cost of treatment

• Total cost for a course of 35 1-hour sessions
  ranges from 5000-6000.
• HCFA approved coverage of External
  Counterpulsation treatment for severe angina on
  July 1, 1999.
• Reimbursement was increased to 143.85 per
  session on Nov 8, 2000.