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Does Enhanced External Counterpulsation (EECP) Significantly Affect Myocardial Perfusion?: A Systematic Review &
Xiaoxia Qin1, Yanye Deng1, Dandong Wu1
1Department of Rehabilitation Medicine, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Insights
Enhanced external counterpulsation (EECP) significantly improves myocardial perfusion in coronary artery disease (CAD) patients. This finding supports EECP use for CAD, potentially explaining improved angina and heart function.
Area of Science:
- Cardiology
- Medical Technology
- Clinical Research
Background:
- Coronary artery disease (CAD) management often involves therapies to improve symptoms and cardiac function.
- The precise mechanisms by which Enhanced External Counterpulsation (EECP) benefits CAD patients are not fully understood.
- Investigating EECP's impact on myocardial perfusion is crucial for understanding its therapeutic effects.
Purpose of the Study:
- To systematically review and meta-analyze existing literature.
- To assess the effect of EECP on myocardial perfusion in patients with CAD.
- To determine if EECP leads to a significant change in myocardial perfusion.
Main Methods:
- Systematic review and meta-analysis of prospective studies.
- Inclusion of studies reporting myocardial perfusion data pre- and post-EECP in CAD patients.
- Statistical analysis using weighted mean difference (WMD) and assessment of heterogeneity and publication bias.
Main Results:
- Standard EECP therapy demonstrated a significant increase in myocardial perfusion (pooled WMD: -0.19).
- Significant statistical heterogeneity was observed (I2 = 89.1%), necessitating a random effects analysis.
- No significant publication bias was detected, supporting the robustness of the findings.
Conclusions:
- Standard EECP therapy significantly enhances myocardial perfusion in patients with CAD.
- The findings support the continued application of EECP for CAD management.
- Increased myocardial perfusion offers a potential physiological explanation for EECP's benefits on angina and left ventricular function.
Background:
Enhanced external counterpulsation (EECP) is currently applied for treating coronary artery disease (CAD) patients. However, the mechanism(s) by which EECP ameliorates angina pectoris and long-term left ventricular function remain largely unknown. The aim of this study will be to assess whether EECP significantly affects myocardial perfusion in CAD patients through a systematic review and meta-analysis of the available literature.
Methods:
MEDLINE, EMBASE, and Cochrane CENTRAL databases were searched for prospective studies on CAD patients that underwent EECP and reported myocardial perfusion data pre- and post-EECP. The impact of EECP was assessed based on the weighted mean difference (WMD) in myocardial perfusion from pre-EECP to post-EECP. Statistical heterogeneity was assessed by the I2 index. Publication bias was assessed through visual inspection of the funnel plot as well as Begg's and Egger's testing.
Results:
Standard EECP therapy (i.e., 35-36 one-hour sessions within a seven-week period) significantly increased myocardial perfusion in CAD patients (pooled WMD: -0.19, 95% CI: -0.38 to 0.00, p = 0.049). A random effects analysis was applied on account of significant heterogeneity (I2 = 89.1%, p = 0.000). There was no evidence of significant publication bias (Begg's p = 0.091; Egger's p = 0.282).
Conclusions:
Standard EECP therapy significantly increases myocardial perfusion in CAD patients. This study's findings support the continued use of standard EECP therapy in CAD patients and provides one putative physiological mechanism to help explain the improvements in angina pectoris and long-term left ventricular function observed in CAD patients after EECP therapy.
