ECP – An Introduction
In today’s ever expanding world of medical technology there are
four main pillars on which non surgical/ interventional
therapies are based
- ECP – External Counter Pulsations
- Cardiac Rehabilitation & Counselling
- Aggressive & correct treatment of atherosclerosis
& its associated risk factors
- Life style modification
The Need forNew Options
Despite optimal medical therapy and invasive procedures, such as angioplasty or cardiac bypass surgery, many patients still experience angina (chest pain, shortness of breath, fatigue) from their coronary artery disease. Daily tasks that most people take for granted such as climbing a flight of stairs, walking a dog, etc. become impossible without experiencing chest pain. For these difficult-to-treat patients, the only option is to significantly curtail daily activities in order to avoid the angina symptoms.
In addition, despite advances in medical therapy for the treatment of congestive heart failure (CHF) over the past decade, substantial unmet needs remain, particularly in patients with moderate to severe CHF. Heart failure is a progressive debilitating condition where the heart is unable to pump enough blood throughout the body. Heart failure develops over time, as the pumping action of the heart grows weaker. Patients with mild heart failure today usually progress to moderate or severe heart failure over time.
For these angina and heart failure patients, FDA-cleared ECP (external counterpulsation therapy) has been demonstrated to provide an effective, non-invasive and enduring therapeutic option. Data from clinical studies and patient registries show that approximately 80 percent of patients benefit from ECP therapy and typically experience: Top
- angina that is less frequent and less intense,
- reduced need for nitroglycerine,
- increased energy levels,
- a greater ability to take part in activities of daily living,
- a better quality of life, and/or
- a more positive outlook.
Results of clinical trials show that ECP is a safe and effective choice for people who are considered at high risk for bypass surgery and angioplasty. The procedure is
- administered in an outpatient setting,
- does not require any surgery or anesthetic, and
- is relatively comfortable for patients.
ECP is not meant to replace bypass surgery or angioplasty, but is an additional treatment for those patients who can no longer benefitfrom surgery or angioplasty.Top
What is E.C.P.
E.C.P. is a nonsurgical, mechanical procedure that can reduce the symptoms of angina pectoris, presumably by increasing coronary blood flow in ischemic areas of the heart. The beneficial effects of ECP in patients with coronary artery disease appear to be sustained between treatments and may persist long after completion of a course of therapy.
What does ECP procedure include?
While ECP is performed, you will be lying on a bed wearing 3 sets of pressure cuffs (like over sized blood pressure cuffs) around calves, lower thighs, and upper thighs including the buttocks. The cuffs inflate rapidly and sequentially—via computer-interpreted electrocardiogram (ECG) signals—starting from the calves and proceeding upward to the buttocks during the diastole.
This has the effect of creating a strong retrograde counter pulse in the arterial system, forcing freshly oxygenated blood towards the heart and coronary arteries, while Simultaneously increasing the volume of venous blood return to the heart under increased pressure.
Just prior to the next heartbeat, before the heart begins to eject blood by contracting (systole), all three cuffs simultaneously deflate, significantly reducing the workload of the heart.
The end result of this sequential “squeezing” of the legs is to create a pressure wave that significantly increases peak diastolic pressure, benefiting circulation to the heart muscle and other organs, while also reducing systolic pressure and systemic vascular resistance to the general benefit of the vascular system.
As the Aortic valve is closed during diastole, the pressure is transmitted into the Coronary Arteries. This pressure tries to overcome blockages much in the same fashion as in Angioplasty.
In addition, due to increase in the Pressure gradient between the well supplied and under supplied areas, formation of collateral circulation takes place; through a process known as Angiogenesis. —’Natural Bypass’.
So, you see, ECP gives the benefits of both-Angioplasty as well as Bypass Top
Mechanism of Action
There are several mechanisms of action for ECP that have been discussed in clinical literature:-
- Improvement of endothelial function
- Promotion of collateral vessels
- Enhancement of ventricular function
- Peripheral training effect with physiologic effects similar to that seen with physical exercise
Treatment with ECP involves a series of 35 one-hour sessions over a period of approximately seven weeks. One can even go to work after the session.
The one-hour treatment sessions with ECP are painless. Because of the natural movement of the pressurized cuffs, chafing and skin irritation can occur. To prevent this, you are advised to wear light fitting pants, such as ankle length bicycle pants. Otherwise, there is virtually no discomfort.
You should continue taking your medication at the regular prescribed dosages throughout the course of treatment and confer with your physician as needed.
There are not known adverse effects as a result of receiving treatment with ECP.
Because each individual's condition is unique, there is no specific time when you can expect to feel an improvement. Experience has shown; however, that patients tend to report some improvement in their condition after as few as 10 or 12 treatments sessions, although others do require longer.
ECP can have a range of benefits depending upon the individual patient. Most patients suffering from chronic disabling angina pectoris have experienced relief of pain associated with this condition after a full course of treatment. In a study of patients with chronic disabling angina, all experienced substantial relief of anginal symptoms after ECP treatment. Typical benefits for patients might include:
- Decrease in chest pain
- Reduction in the use of medication
- Ability to enjoy a more independently mobile and active lifestyle
While it is not expected that everyone suffering from chronic angina pectoris will experience the same level of improvement, it does appear that ECP is an effective therapy for many angina patients.
Bypass surgery &Angioplasty will have its place. Each patient needs to be assessed & the treatment modality has to be customised for his/her symptoms & level of disability & other co-morbid conditions like diabetes, COPD, LVF, etc.
At present, there are many thousand units of ECP functioning worldwide with more than nine hundred units working in USA. Worldwide, more than 50,000 patients have been treated with ECP and five-year survival data, which has emerged, is very impressive.
There are around 20 ECP units working in our country at present.The use of ECP in India will see an exponential curve in the coming years because of non-invasive nature & substantial cost benefit to the patient.
No, there is a list of Indications and Contraindications issued by the USFDA. We have to adhere to that. Such cases wherein ECP is contraindicated is 2% and wherein Bypass or Angioplasty are better suited alternatives are only 20%. Therefore, for approx. 80% patients, ECP is the treatment of choice.
It is approximately only 25% of the cost of Angioplasty or Bypass & that too without hospitalisation.