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Anthony N. DeMaria MD, MACC Judith and Jack White Chair in Cardiology, Professor of Medicine, Chief, Cardiovascular Medicine. University of California at San Diego San Diego, California Member, Scientific Council (Vasomedical). History and Clinical Development of EECP.
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Anthony N. DeMaria MD, MACCJudith and Jack White Chair in Cardiology, Professor of Medicine, Chief, Cardiovascular Medicine.University of California at San Diego San Diego, CaliforniaMember, Scientific Council (Vasomedical) History and Clinical Development of EECP
Evolution of Counterpulsation Birtwell’s Arterial Counterpulsator Intra-Aortic Balloon Pump External Counterpulsation
Increased Coronary Artery Perfusion 120 C D F mm Hg 100 B B 80 E A Reduced Myocardial O2 Demand Counterpulsation Timing A = One complete cardiac cycle B = Unassisted aortic end-diastolic pressure C = Unassisted systolic pressure D = Diastolic Augmentation E = Reduced aortic end-diastolic pressure F = Reduced systolic pressure
Intracoronary Pressure with EECP Michaels et al; Circ. 106, 2002
EECP: Effect on Exercise* (MUST-EECP) p > 0.3 p = 0.01 Time (Seconds) Exercise Duration Time to ST Depression * Adjusted mean of change from baseline Arora RR, et al. J ACC 1999;33
MUST-EECP: DailyAngina Counts Active (N=57) Sham(N=59) Active (N=71) Sham (N=66) Per Protocol ( ≥ 35 hours ) } P < 0.02 Intention-to-treat (all patients) } P < 0.05 % Change MUST-EECP Arora RR, et al. J Am Coll Cardiol 1999;33:1833-40
HQOL Changes Using SF36 and QL Index Instruments (Baseline to 1 Yr Follow-up) Physical Functioning (Work) Role Disability Due to Physical Health Bodily Pain General Health Vitality St. Sig. Within Group Difference St. Sig. Between Group Difference Social Functioning (Work) Role Disability Due to Emotional Health Mental Health Cardiac Specific Health & Functioning Magnitude of Improvement or Decline Expressed in Standard Deviation Units
INTERNATIONAL EECP PATIENT REGISTRY Phase I 92 Centers • 82 in United States • 5 in Europe • 5 Other international 5222 patients enrolled 5718 courses of EECP therapy Data on File: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh
Change in Angina Class with EECP: IEPR Michaels et al; AJC. 2004
Symptomatic Coronary Artery DiseasePopulation need and suitability Medication Needing intervention Inoperable or high risk
EECP Symposium Patient selection Results of clinical trial-work Future indications Heart Failure Possible mechanisms First-hand clinical experience