title: The benefits and safety of external counterpulsation in symptomatic heart failure.
abstract: BACKGROUND
  External counterpulsation is a safe and effective method of alleviating angina pectoris, but the mechanism of benefit is not understood.
  
  
  OBJECTIVE
  To evaluate the safety and efficacy of external counterpulsation therapy in heart failure patients.
  
  
  METHODS
  Fifteen symptomatic heart failure patients (subsequent to optimal medical and device therapy) underwent 35 hourly sessions of ECPT over a 7 week period. Before and after each ECPT session we performed pro-B-type natriuretic peptide and brachial artery function studies, administered a quality of life questionnaire, and assessed exercise tolerance and functional class.
  
  
  RESULTS
  Baseline left ventricular ejection fraction was 28.1+/-5.8%. ECPT was safe and well tolerated and resulted in a reduction in pro-BNP levels (from 2,245+/- 2,149 pcg/ml to 1,558+/-1206 pcg/ml, P= 0.022). Exercise duration (Naughton protocol) improved (from 720+/-389 to 893+/-436 seconds, P= 0.0001), along with functional class (2.63+/-0.6 vs. 1.93+/-0.7, P= 0.023) and quality of life scores (54+/-22 vs. 67+/-23, P= 0.001). Nitroglycerine-mediated brachial vasodilatation increased (11.5+/-7.3% vs. 15.6+/-5.2%, P=0.049), as did brachial flow-mediated dilation (8.35+/-6.0% vs. 11.37+/-4.9%, P= 0.09).
  
  
  CONCLUSIONS
  ECPT is safe for symptomatic heart failure patients and is associated with functional and neurohormonal improvement. Larger long-term randomized studies with a control arm are needed to confirm these initial encouraging observations.
authors.affiliation: Department of Cardiology, Assaf Harofeh Medical Center, Zerifin, Israel. ekaluski@gmail.com
authors.forename: Edo
authors.initials: E
authors.lastname: Kaluski
authors.forename: Ziad
authors.initials: Z
authors.lastname: Gabara
authors.forename: Nir
authors.initials: N
authors.lastname: Uriel
authors.forename: Olga
authors.initials: O
authors.lastname: Milo
authors.forename: Marina
authors.initials: M
authors.lastname: Leitman
authors.forename: Jerald
authors.initials: J
authors.lastname: Weisfogel
authors.forename: Vladimir
authors.initials: V
authors.lastname: Danicek
authors.forename: Zvi
authors.initials: Z
authors.lastname: Vered
authors.forename: Gad
authors.initials: G
authors.lastname: Cotter
mesh_terms: D000328:Adult; D000368:Aged; D001916:Brachial Artery / Q000502:physiology; D015908:Counterpulsation / Q000009:adverse effects* / Q000379:methods*; D005080:Exercise Test; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000628:therapy; D016277:Ventricular Function, Left