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Is there any other larger study available to show the long time patient benefit? |
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International ECP Patient Registry at the University of Pittsburgh Graduate School of Public Health points to sustained lowering of Anginal severity and frequency of attacks at six, twelve and thirty- six months post-treatment.
Please refer the graphical forms to the doctors. |
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How popular is this treatment? |
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In USA 1996 ECP got FDA cleared and 1999 Medicare Insurance coverage. Leading Cardiology centers like Mayo clinic and Cleveland clinic has ECP center. In India Leading Cardiology centers like Pushpagiri Heart Institute, Escorts, Apollo, Birla Heart Institute, Asian heart etc are treating the patients with ECP. Nearly 50 ECP centers are already available in India. |
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When will the patient experience the clinical Improvement? |
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Usually the patients start experiencing the improvement by 10 to 15 days. The clinical improvements are decrease or elimination of Anginal pain after exertion, more walking distance, Less intake of nitroglycerine, Improvement in quality of life, and Improvement in over all health status. |
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How can the cardiologist assess the patient's improvement? |
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The objective finding which the cardiologist can assess are improvement in Treadmill exercise time, time to ST segment depression, Improvement in stress perfusion study at same cardiac work load 83% (American Journal of Cardiology April 2002), Improvement in Ejection fraction, Improvement in end diastolic filling pressure. Improvement in regional ischemial regional myocardial blood flow reserve evaluated by ammonia positron emission tomography. |
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What are the side effects of the treatment? How safe is the treatment? |
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ECP is a Non-Invasive and out patient treatment. When considering with other interventional procedures it is very safe. The completion or compliance of patients for 35 days treatment is above 90%. The only adverse effects reported in randomized trail are skin abrasion or lesions because of pressure. |
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Is there any Randomized control trail to show the benefit of ECP over the placebo group? |
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To show the safety and efficacy of ECP treatment over placebo group the first Multicenter Randomized Control trail of Enhance External Counterpulsation (MUST-ECP) was completed and published in 1999 on American Journal of Cardiology November 7th. The results clearly shows the reduction of angina and increase time to ST segment depression in active Counterpulsation group when compare the inactive or placebo group. The follow up data of this patients where published in Journal of Investigational medicine 2002. The patient's health related Quality of life improvement after the treatment sessions where not only maintained after 1 year but they are more pronounced. |
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Is there any comparison of ECP treatment with other interventional treatments like Bypass and angioplasty? |
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Even though the patients treated with ECP are sicker group when compare to the patient undergone interventional procedures the results are comparable in spite of the disparity of risk profile in the two groups.
The 5-year survivals of ECP patients are 88% similar to the results seen in contemporary Bypass and angioplasty trail. (April 2000 clinical cardiology)
Study comparing two ECP registries at Pittsburgh and Angioplasty registry at National heart lung and Blood institute (American Journal of Cardiology 2002 may 15th issue) shows the 1-year survival and adverse events results are comparable. But 17.2% of angioplasty patients went for repeat angioplasty procedure while only 6.3 % of ECP patients underwent repeats ECP. Also twice the no of patients in Angioplasty group reported to use Short time nitroglycerin when compare to ECP group.
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What evidence is there to show ECP opens dormant collaterals and also stimulate new vessel formation (Angiogenesis)? |
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Pre and post thallium stress test has shown 83 percent improvement in stress nuclear perfusion study (American College of Cardiology 2002 April issue)
Increase in Vaso-Endothelial Growth factor a potent angiogenic factors have been recorded during and after 1 month of ECP treatment. (European Heart Journal 2001)
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Is there any clinical study available about ECP treatment in leading cardiology journal? |
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From 97 onwards after FDA clearance for ECP treatment there are more than 45 journal publication and more than 75 abstracts, and editorials publication world wide about ECP treatment Hemodynamics, clinical efficacy, safety in heart failure and long time benefit. |
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What are all the clinical improvements the patient may experience after 35hrs of ECP treatment (1 course)? Do they need additional course? |
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After ECP treatment the patient will experience the following benefit |
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Increase exercise time with out chest pain. |
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Complete freedom from agonizing chest pain or decrease in the chest pain frequency and intensity |
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Improvement in overall health |
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Decrease or no need for anti Anginal medications. |
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Patients feel more comfort for participating in social activities without fear of getting chest pain. |
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Some patients with severe three-vessel disease may need more than 35 hrs of treatment, which will be determined by his cardiologist by assessing his improvement. Usually one course of treatment is sufficient up to 5 yrs according to the available long time follow up study. Few patients may require additional course of treatment according to the severity of coronary artery disease. |
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What are the advantages of ECP over other conventional treatment? |
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ECP is the only treatment which is neither Invasive nor pharmacological. ECP is a completely Non-Invasive and outpatient procedure. |
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ECP treatment carries very low or no major adverse event during treatment |
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ECP is effective in small vessel of the heart those that are too small for bypass and angioplasty this is the main reason why ECP still be effective when other procedures have failed. |
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The effectiveness of ECP seems to be similar in both diabetes and non-diabetes. (Circulation 2000; 102-18) |
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ECP can be safely administered even in patients with left ventricular dysfunction with
ejection fraction lower than 35%. |
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ECP benefit seems to be similar in both Ischemic and Idiopathic Cardiomyopathy. (CHF. 2002; 204-208,227) |
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ECP is cost effective and very safe treatment. It is painless and need no hospitalization. |
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What are the objective evidences to show the ECP treatment benefit in Congestive Heart failure? |
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Increase in exercise duration |
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Increase in peak oxygen uptake |
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Increase cardiac output |
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Reduce systemic vascular resistance |
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Improvement in preload-adjusted maximal power. |
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Improvement in ejection fraction |
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Decrease in heart rate |
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Improved diastolic filling pressure associated with decrease Brain Natriuretic peptide (BNP) |
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Trend towards Normalization of Neurohormonal activation is noted. Increase in nitric oxide and decrease in endothelin. |
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Increase renal perfusion decreases plasma renin activity. |
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Decrease renin-Angiotensin system axis activation. |
