Patient Selection

1.Chronic CAD

Primary utilization of EECPis those who no longer respond to medication.

(a) Surgery / PTCA not contemplated

Patients may not be amenable to PCI or CABG due to following:

• Patients who refused for invasive procedure.
• Diffuse distal disease.
• Target lesion is inaccessible.
• LV dysfunction—High risk CABG.
• Restenosis after PTCA.

(b) Preparation for Revascularization

• Severe LV Dysfunction with lot of hibernation to Stabilize Heart Function.
• Waiting due to some other reason.

2.Heart Failure

• Non-Ischemic cardiomyopathy.
• Ischemic Cardiomyopathy.
• Patient with LV Dysfunction.
• Patient with moderate to severe levels of CHF.

3.Microvascular Angina

Cardiac syndrome X

4. Acute Coronary Syndrome

• Unstable Angina.
• Acute MI.
• Cardiogenic shock.

Contraindications Check List

• Significant AR.
• DVT/active thrombophlibities.
• Congenital Heart Disease.
• Gross CHF.
• Uncontrolled arrhythmia AF, VT, Frequent VPC’s.
• Extreme Hypertension (BP>180/110mmHg).
• Extreme Tachycardia (HR>120 BPM).
• Cardiac Cath in Prior 1-2 weeks.
• Bleeding Diathesis.
• Pregnancy.

Precautions

Precautions In some patients with a history of congestive heart failure (CHF) or low ejection fraction, left ventricular function may be insufficient to compensate for increased venous return during EECP. These patients should have their fluid balance closely monitored. Cuff pressure and deflation timing should be optimized for achieving maximum after load reduction and reducing the possibility of pulmonary congestion.

EECP should be withheld if there is exacerbation of heart failure symptoms and may be resumed once the patient has been stabilized. In patient with manageable edema with LVEF>35% continuous monitoring of oxygen saturation should be initiated.

Severe peripheral vascular disease including significant ileofemoral arterial obstruciton may limit the effectiveness of EECP treatment due to decreased blood flow.

Patient suspected of having an abdominal aortic aneurysm should be evaluated for its clinical significance prior to treatment with EECP.

EECP in heart failure patients

Patient with LVD with history of heart failure a course of EECP treatment has shown to decrease the Endothelin and nitric oxide ratio. This shift results in vasodilatation, which is persistent even after 3 months of completion of treatment. EECP thus benefits the patient with both ischemic and idiopathic cardiomyopathy independent of effect on Angiogenesis and collateral formation.

Safety of EECP in patients with Congestive Heart failure.

(General Cardiology 2001 Lawson et al.). During treatment only 5.5% experienced worsening of their congestive heart failure. In six months follow up study of 444 patents with history of CHF with EF less than 39%, 88% with multiple vessel disease only 19% where re-hospitalize for CHF, which is only 1/3 rd of the expected re-hospitalization when compare to other randomize study with similar patient group.