Heart Failure

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

Arthur M. Feldman, MD, PHD, FACC,* 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,# Thomas Varricchione, MBA, RRT,** for the PEECH Investigators

Philadelphia, Pennsylvania; Oak Lawn, Illinois; Cleveland, Cincinnati, and Columbus, Ohio; Pittsburgh, Pennsylvania; Stockton, New Jersey; and Westbury, New York

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 andprotocol-defined pharmacologic therapy (PT) or PT alone. Two co-primary end points werepre-defined: the percentage of subjects with a 60 s or more increase in exercise duration andthe percentage of subjects with at least 1.25 ml/min/kg increase in peak volume of oxygenuptake (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. (JAm Coll Cardiol 2006;48:1198 –205) © 2006 by the American College of Cardiology Foundation

Cardiology 2001;96(2):78-84

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