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May 2003

A Non-Invasive Alternative to
Coronary Artery Bypass Surgery

What other conditions may be treated with EECP?

The most common cause of congestive heart failure (CHF) is coronary artery disease. Each vessel provides a region of the myocardium with bloodflow, so when the circulation is impaired-or clots occur with local cell death-the muscle function deteriorates. Despite centuries of research and "conventional" approaches, medical treatments for CHF are often inadequate. Many patients require a heart transplant and sadly for most the post-operative prognosis is grim.28,29

Because of its potential value in the treatment of congestive heart failure, EECP has recently been the focus of numerous studies, most notably the PEECH study (Prospective Evaluation of EECP in Congestive Heart Failure). According to Dr. Marc Silver, a member of the PEECH committee and author of Success with Heart Failure30 EECP holds remarkable potential.

"It is clear that EECP is a useful adjunctive therapy for patients with coronary artery disease and early evidence suggests that it is safe and effective in patients whether or not they have a degree of heart failure. What is really exciting is whether EECP might turn out to also be a useful adjunctive therapy for heart failure itself; that is what the early results suggest and that is precisely what the PEECH trial is all about. Heart failure is our new national health care epidemic and there is only so much that can be done with medications; increasingly we are turning to other solutions."31,32


In China the EECP machine is used to treat a variety of problems and studies are currently underway to further define the boundaries of its benefits.33 For example, since EECP increases blood flow everywhere, not just to the heart, organ dysfunction present because of reduced blood flow could thus improve during EECP. Chinese physicians use arm cuffs during the procedure, further increasing blood flow to the brain. In this fashion EECP can be used in the treatment of stroke. This ability of EECP to improve blood flow in general may lead to some additional applications of EECP in this country and around the world.6,31

Despite being developed almost 50 years ago, EECP is a resource that has gone overlooked for far too long. The time has come for External Counterpulsation to become a part of the generally available armamentarium for Cardiology and for general prevention and wellness.

To be referred for EECP, talk with your doctor or your cardiologist. However, many otherwise excellent cardiologists are not fully familiar with EECP, and many tend to push their patients toward experimental or invasive procedures or more drugs, so you may need to seek several opinions. If you or your physician are unaware of EECP they can find more information at:

Nicore, Inc. Tampa, FL
(888) 317-3327 or Nicore started marketing early in 2001, and there are more than 60 systems in use around the U.S.9

Vasomedical,, Westbury, NY (800) 455-3327(EECP). There are over 650 active installations around the world.

CardioMedics Irvine, CA (888) 849-0200 x 102. The original patent was issued to this company in 1986. As of this writing, there are 165 CardiAssist® machines in use around the U.S.9,40


1. David Brown of the Washington Post "Shaking Up Heart Therapy". Los Angeles Times, July 30, 2001.

2. Shari Rudavsky "Gentle care for hearts: Out-patient therapy offers painless alternative to surgery for angina patients." The Miami Herald, Living Today, March 21, 2002.

3. Warren Strugatch, "Struggling to Get Doctors' Attention." New York Times, Long Island Weekly Desk; December 15, 2002, Sunday , New York Times.

4. Lawson WE, Hui JCK, Oster ZH, et al. Enhanced external counterpulsation as an adjunct to revascularization in unstable angina. Clinical Cardiology 1997, 178-180.

5. Medicare Part B Manual-Florida, Medical Policy Procedures (4-PCRB2000-077) Feb/March 2000 Bulletin, 2/27/2000, "External Counterpulsation."

6. Wu G. A neurohormonal mechanism for the effectiveness of enhanced external counterpulsation. Circulation 100:18; Suppl. 1 Abstract 4388.

7. Urano H. Intermittent shear stimuli by enhanced external counterpulsation (EECP) restores endothelial function in patients with coronary artery diseases. Circulation 102:18 Suppl. II Oct. 2000.

8. Kantrowitz A. Experimental augmentation of coronary flow by retardation of arterial pulse pressure. Surgery. 1953; 34:678-687.

9. Personal Communications, Vasomedical, Inc. and Cardiomedics, Inc., 2002-2003.

10. Aurora, R, et al. The multicenter study of Enhanced External Counterpulsation (MUST-EECP): Effect of EECP on exercise-induced myocardial ischemia and anginal episodes. Circulation Abstracts 10/97 and Journal of the American College of Cardiology 1999;33:1833-40.

11. Weisfogel et al., External Counterpulsation produces a significant reduction in stable angina class, episodes, medication use, and hospitalization. Cardiovascular Reviews and Reports 3, 2002.

12. Taguchi, I, et al. Comparison of hemodynamic effects of Enhanced External Counterpulsation and Intra-Aortic balloon pumping in patients with acute myocardial infarction. The American Journal of Cardiology 2000;86:1139-41.

13. Katz, WE et al. Effects of Enhanced External Counterpulsation on internal mammary artery flow: comparison with intra-Aortic Balloon Counterpulsation. Oral Presentation 825-1, American Heath Association Meeting, 1998.

14. Amsterdam E, Banas J, Clinical assessment of external pressure circulatory assistance in acute myocardial infarction, JACC 1979.

15. Zheng ZS, Pan JY Wu SX. The improvement or myocardial ischemia after Intra Aortic balloon pumping. J New Med (Chinese)1977;6:269-271.

16. Karim S et al. Enhanced External Counterpulsation protects coronary artery disease patients from future cardiac events. 1st International Congress on heart disease - new trends in research, diagnosis and treatment. The Journal of Heart Disease 1:1 May 1999.

17. DeMaria AN. A historical overview of Enhanced External Counterpulsation. Clin.Cardiol.Suppl.II, Vol 25, II3-II5, 2002.

18. Zarins CK, Zatina MA, et. al. Shear stress regulation of artery lumen diameter in experimental atherogenesis. J Vascular Surgery 1987;5:413-420.

19. Fricchione GL, et al. Psychosocial effects of Enhanced External Counterpulsation in the angina patient. Psychosomatics 1995;36:494-97.

20. Urano, H. Enhanced External Counterpulsation improves exercise tolerance, reduces exercise-induced myocardial ischemia and improves left ventricular diastolic filling in patients with coronary artery disease. J Am Coll Cardiol 2001;37:93-9.

21. Florida Medicare Participating Fee Schedule, Locality Report for service G0166, Medicare Part B Bulletin, Page 2, Published by First Coast Service Options, 2002.

22. Lawson WE, Hui JCK, Zheng ZS, et al. Three-year sustained benefit from Enhanced External Counterpulsation in chronic angina pectoris. American Journal of Cardiology 1995; 75:840-841.

23. International EECP Patient registry, University of Pittsburgh Graduate School of Public Health,


24. Lawson et al. Quality of Life Benefits in the International EECP Registry Study. 20th Congress of the European Society of Cardiology Abstract P505 September 1998 Vienna, Austria.

25. Vasomedical, Inc., "EECP Bibliography" with approximately 200 citations to the medical literature.

26. Feldman AM, Enhanced External Counterpulsation: Mechanism of Action. - Clin.Cardiol.Suppl.II, Vol 25, II13-15 2002.

27. Roberts JC, Literature Review,Center of NW Ohio, EECP Center of NW Ohio at Comprehensive Heart Care  4407 W. Sylvania Ave., Suite 200   Toledo, Ohio 43623   (419) 882-9625 , with permission.

28. Strobeck, JE. Enhanced External Counterpulsation is a Safe and Effective Treatment for Angina in Patients with Severe Left Ventricular Dysfunction. Journal of Cardiac Failure 5:3 Suppl. 1 Abstract 268 1999.

29. Textbook of Primary Care Medicine, 3rd ed., Copyright 2001 Mosby, Inc. p. 584.

30. Silver, MA, Success with Heart Failure: Help and Hope for Those with Congestive Heart Failure. Perseus Publishing; 3rd edition, October 16, 2002.

31. Conti CR, Ed., EECP Current Experience and Future Directions, Clinical Cardiology, 12/2002, Volume 25, Suppl II, pII-1-26, ff.

32. Conti CR, Ongoing and Planned Studies of Enhanced External Counterpulsation. Clin.Cardiol.Suppl II 26-28, 2002.

33. Ho Jian Wu, Probe to the Indications , contradictions, course and therapeutic effect of ECP treatment. Chinese External Counterpulsation Journal5:1-9, 1993, Translated by Huang Z, Los Angeles, Aug 1995.

34. Werner et al. Blood Pressure Changes During External Counterpulsation. 20th Congress of the European Society of Cardiology Abstract 3659 September 1998 Vienna, Austria.

35. Offergeld, C, Werner, D, et al. Pneumatic External Counterpulsation (PECP): A New Treatment Option for Therapy-Resistant Inner Ear Disorders? Laryngo-Rhino-Otologie Abstract L-R-O 9.

36. Froschermaier S, Enhanced External Counterpulsation as a New Treatment Modality for Patients with Erectile Dysfunction. Urologia Internationalis 1998;61:168-171.

37. Werner, D. Pneumatic External Counterpulsation: A New Noninvasive Method to Improve Organ Perfusion. The American Journal of Cardiology 1999;84:950-52.

38. Werner et al. Improvement of Renal Perfusion and Function by Pneumatic External Counterpulsation. D. 20th Congress of the European Society of Cardiology Abstract P3660 September '98 Vienna, Austria.

39. Xiao-Xian Quan et al. Effect of Enhance External Counterpulsation on Lipid Peroxidation in Coronary Disease. 1st International Congress on Heart Disease - New Trends in Research, Diagnosis, and Treatment. The Journal of Heart Disease 1:1 May 1999.

40. Juetersonke, George J., D.O., Passing on Bypass, Pikes Peak Press, 2000.