title: Enhanced external counterpulsation improves exercise tolerance in patients with chronic heart failure.
abstract: OBJECTIVE
  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), 3months (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.
authors.affiliation: Department of Medicine, Jefferson Medical College, Philadelphia, Pennsylvania, USA. Arthur.Feldman@jefferson.edu
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Feldman
authors.forename: Marc A
authors.initials: MA
authors.lastname: Silver
authors.forename: Gary S
authors.initials: GS
authors.lastname: Francis
authors.forename: Charles W
authors.initials: CW
authors.lastname: Abbottsmith
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Fleishman
authors.forename: Ozlem
authors.initials: O
authors.lastname: Soran
authors.forename: Paul-Andre
authors.initials: PA
authors.lastname: de Lame
authors.forename: Thomas
authors.initials: T
authors.lastname: Varricchione
mesh_terms: D000368:Aged; D002908:Chronic Disease; D015908:Counterpulsation / Q000379:methods*; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index