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CLINICAL RESEARCH: ENHANCED EXTERNAL COUNTERPULSATION

Enhanced External Counterpulsation Improves Exercise Tolerance in Patients With Chronic Heart Failure

Arthur M. Feldman, MD, PhD, FACC^_*,1,_*, Marc A. Silver, MD, FACC, Gary S. Francis, MD, FACC, Charles W. Abbottsmith, MD, FACC, Bruce L. Fleishman, MD, FACC^||, Ozlem Soran, MD, MPH, FACC, FESC^¶, Paul-Andre de Lame, MD^#,2, Thomas Varricchione, MBA, RRT^_**,3 for the PEECH Investigators

^_* Department of Medicine, Jefferson Medical College, Philadelphia, Pennsylvania
Department of Medicine and the Heart Failure Institute, Advocate Christ Medical Center, Oak Lawn, Illinois
Department of Cardiology, The Cleveland Clinic, Cleveland, Ohio
The Lindner Center, Cincinnati, Ohio
^|| The Cardiovascular Research Institute, Columbus, Ohio
^¶ UPMC Cardiovascular Institute, Pittsburgh, Pennsylvania
^# Anabase International, Stockton, New Jersey
^_** Vasomedical, Inc., Westbury, New York.

Manuscript received June 22, 2005; revised manuscript received August 31, 2005, accepted October 19, 2005.

^_* Reprint requests and correspondence: Dr. Arthur M. Feldman, Department of Medicine, Jefferson Medical College, 1025 Walnut Street, Philadelphia, Pennsylvania 19107. (Email: Arthur.Feldman{at}jefferson.edu).

A preliminary report of this data was presented at the late-breaking clinical trials session at the 54th Annual Meeting of the American College of Cardiology in Orlando, Florida, March 2005. Illeana Piña, MD, served as guest editor for this paper.

OBJECTIVES: The PEECH (Prospective Evaluation of Enhanced External Counterpulsation in Congestive Heart Failure) study assessed the benefits of enhanced external counterpulsation (EECP) in the treatment of patients with mild-to-moderate heart failure (HF).

BACKGROUND: Enhanced external counterpulsation reduced angina symptoms and extended time to exercise-induced ischemia in patients with coronary artery disease, angina, and normal left ventricular function. A small pilot study and registry analysis suggested benefits in patients with HF.

METHODS: We randomized 187 subjects with mild-to-moderate symptoms of HF to either EECP and protocol-defined pharmacologic therapy (PT) or PT alone. Two co-primary end points were pre-defined: the percentage of subjects with a 60 s or more increase in exercise duration and the percentage of subjects with at least 1.25 ml/min/kg increase in peak volume of oxygen uptake (VO₂) at 6 months.

RESULTS: By the primary intent-to-treat analysis, 35% of subjects in the EECP group and 25% of control subjects increased exercise time by at least 60 s (p = 0.016) at 6 months. However, there was no between-group difference in peak VO₂ changes. New York Heart Association (NYHA) functional class improved in the active treatment group at 1 week (p < 0.01), 3 months (p < 0.02), and 6 months (p < 0.01). The Minnesota Living with Heart Failure score improved significantly 1 week (p < 0.02) and 3 months after treatment (p = 0.01).

CONCLUSIONS: In this randomized, single-blinded study, EECP improved exercise tolerance, quality of life, and NYHA functional classification without an accompanying increase in peak VO₂.

Abbreviations and Acronyms   EECP = enhanced external counterpulsation   HF = heart failure   LV = left ventricular   LVEF = left ventricular ejection fraction   MLWHF = Minnesota Living with Heart Failure   NYHA = New York Heart Association   PEECH = Prospective Evaluation of Enhanced External Counterpulsation in Congestive Heart Failure trial   PT = protocol-defined pharmacologic therapy   VO2 = oxygen uptake

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