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Gregory W Barsness, MD Director, EECP Program Mayo Clinic Rochester, MN

EECP: Pushing forward. Gregory W Barsness, MD Director, EECP Program Mayo Clinic Rochester, MN. EECP:Pushing forward. The process. Cuffs inflate sequentially to milk blood up to the heart in diastole. (click to view animation). EECP:Pushing forward. Indications/contraindications.

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Gregory W Barsness, MD Director, EECP Program Mayo Clinic Rochester, MN

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  1. EECP: Pushing forward Gregory W Barsness, MD Director, EECP Program Mayo Clinic Rochester, MN

  2. EECP:Pushing forward The process • Cuffs inflate sequentially to milk blood up to the heart in diastole. • (click to view animation)

  3. EECP:Pushing forward Indications/contraindications INDICATIONS: Symptomatic ischemic coronary disease CONTRAINDICATIONS: Aortic insufficiency Severe valvular disease Cardiac catheterization <2 weeks Arrhythmia Severe hypertension (>180/110mmhg) History of DVT

  4. EECP:Pushing forward Pilot study 8 patients received 35 separate EECPsessions, each lasting for 1 h, over 7 weeks Dr John Gorcsan, 49th Annual Scientific Session of the American College of Cardiology

  5. EECP:Pushing forward MUST-EECP 139 patients randomized to either active or inactive EECP (double-blind) Arora RR, et.al. J Am Coll Cardiol 1999; 33:1833-1840

  6. EECP:Pushing forward What’s next Congestive Heart Failure study Approved Sept 6, 2000 by the FDA 180 patients in 18 centers across the US

  7. EECP:Pushing forward Mechanism Exact mechanism unknown, but possibilities include: 1) collateral development provoked through increased expression of growth factors 2) Passive exercise (blood pressure modification, sympathetic and neurohormonal changes)

  8. EECP:Pushing forward Hurdles to acceptance “It’s a difficult therapy to watch. It’s a lot of motion, it’s an aggressive diastolic milking of the blood centrally. On the table, patients are bouncing around and it’s a little uncomfortable for the patients to start. It’s not painful at all, but it’s a little uncomfortable.” Gregory W Barsness, MD Director, EECP Program Mayo Clinic Rochester, MN

  9. EECP:Pushing forward When to use ECP Should be used in patients unable to be revascularized a second time and those in whom medical therapy has failed. Avoid using in patients with active deep venous thrombosis. Doesn’t work well in people with claudication. Approximately 10% of patients cannot tolerate EECP therapy, due to leg or back pain, or leg and skin abrasions caused by the leg cuffs.

  10. EECP:Pushing forward Long term follow up International EECP Patient Registry (University of Pittsburgh Graduate School of Public Health) 2800 patients 3300 cases Intends to track 5000 patients with 3 year follow-up.

  11. EECP:Pushing forward Cost of treatment Total cost for a course of 35 1-hour sessions ranges from $5000-6000. HCFA approved coverage of External Counterpulsation treatment for severe angina on July 1, 1999. Reimbursement was increased to $143.85per session on Nov 8, 2000.

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