External counterpulsation for the treatment of patients with refractory angina

Применение наружной контрпульсации для лечения пациентов с рефрактерной стенокардией
Rovshan Alakbarov 1, Tofig Jahangirov 1, Orazbek Sakhov 2, Sholpan Zhangelova 3
More Detail
1 Cardiac Failure Department, J.Abdullayev Scientific Research Institute of Cardiology, Baku, Republic of Azerbaijan
2 X-Ray Surgery Department, City Heart Center, Almaty, Republic of Kazakhstan
3 №2 Internal Medicine Department, Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
J CLIN MED KAZ, Volume 2, Issue 48, pp. 14-21. https://doi.org/10.23950/1812-2892-JCMK-00576
Download Full Text (PDF)


Despite the great advances in conventional medical and invasive treatment of patients with coronary heart disease, a significant number of these patients continues to have a resistant to standard therapy angina pectoris. Many of these patients are not candidates for subsequent myocardial revascularisation procedures for many reasons, and optimal medical treatment is not allowed to effectively control the symptoms of angina pectoris. To treat this category of patients, a large number of different treatment methods have been proposed. External counterpulsation is one of the methods of treatment of patients with refractory angina.


Alakbarov R, Jahangirov T, Sakhov O, Zhangelova S. External counterpulsation for the treatment of patients with refractory angina. Journal of Clinical Medicine of Kazakhstan. 2018;2(48):14-21. https://doi.org/10.23950/1812-2892-JCMK-00576


  • WHO Mortality Database, May 2014 update. World Health Organization, Department of Health Statistics and Information Systems, Geneva, Switzerland. World Health Organization, 2014. http://www.who.int/healthinfo/statistics/mortality_rawdata/en/ index.html.
  • Zaher C, Goldberg GA, Kadlubek P. Estimating angina prevalence in a managed care population. Am J Manag Care. 2004 Oct;10(11 Suppl):S339-346.
  • Hilton TC, Chaitman BR. The prognosis in stable and unstable angina. Cardiol Clin. 1991 Feb;9(1):27-38.
  • Kevin Cheng, Paul Sainsbury, Michael Fisher, Ranil de Silva. Management of refractory angina pectoris. European Cardiology Review 2016;11(2):69–76.
  • Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, Crea F, Cuisset T, Di Mario C, Ferreira JR, Gersh BJ, Gitt AK, Hulot JS, Marx N, Opie LH, Pfisterer M, Prescott E, Ruschitzka F, Sabaté M, Senior R, Taggart DP, van der Wall EE, Vrints CJ. 2013 ESC guidelines on the management of stable coronary artery disease. European Heart Journal 2013;34:2949–3003.
  • Kantrowitz A., Kantrowitz A. Experimental augmentation of coronary flow by retardation of arterial pressure pulse. Surgery 1953;34:678-687.
  • Dennis C, Moreno JR, Hall DP, Grosz C, Ross SM, Wesolowski SA, Senning A. Studies external counterpulsation as a potential measure for acute left heart failure. Trans Am Soc Artif Intern Organs. 1963;9:186-191.
  • Birtwell W, Giron F, Soroff H, Ruiz U, Collins J, Deterling R. Support of the Systemic Circulation and Left Ventricular Assist by Synchronous Pulsation of Extramural Pressure. Trans Am Soc Artif Intern Organs. 1965;11:43-51.
  • Giron F, Birtwell WC, Soroff HS, Ruiz U, Collins JA, Deterling RA, Jr. Assisted circulation by synchronous pulsation of extramural pressure. Surgery 1966;60:894-901.
  • Zheng ZS, Li TM, Kambic H, Chen GH, Lu LQ, Cai SR, Zhan CY, Chen YC, Wo SX, Chen GW. Sequential external counterpulsation (SECP) in China. Trans Am Soc Artif Intern Organs. 1983;29:599-603.
  • Soroff HS, Birtwell WC. Clinical evaluation in synchronous external counterpulsation in cardiogenic shock. J Cardiovasc Surg (Torino). 1973;Spec No:752-756.
  • Soroff HS, Cloutier CT, Birtwell WC, Begley LA, Messer JV. External counterpulsation. Management of cardiogenic shock after myocardial infarction. Jama. 1974;229:1441-1450.
  • Amsterdam EA, Banas J, Criley JM, Loeb HS, Mueller H, Willerson JT, Mason DT. Clinical assessment of external pressure circulatory assistance in acute myocardial infarction. Report of a cooperative clinical trial. Am J Cardiol. 1980;45:349-356.
  • Cloutier CT, Soroff HS, Giron F, Birtwell WC, Messer JV, Ryan TJ, Flessas A, Lutten C, Evans GL, Ehrich DA, Waltuch T, Hoell JF. The physiologic effects of synchronous external circulatory assistance in patients in cardiogenic shock. Surg Forum. 1971;22:187-188.
  • Cloutier CT, Soroff HS, Birtwell WC, Banas JS, Brilla AH, Begley LA, Childs P, Messer JV. Clinical evaluation of synchronous external circulatory assistance in cardiogenic shock. Surg Forum. 1972;23:170-172.
  • Banas J.S., Brilla A., Soroff H.S.. Evaluation of external counterpulsation for treatment severe angina pectoris. Circulation 1972;46(Suppl II):II-74.
  • Lawson WE, Hui JCK, Soroff HS, et al. Efficacy of enhanced external counterpulsation in the treatment of angina pectoris. The American Journal of Cardiology 1992;70:859-862.
  • Arora RR, Chou TM, Jain D, Fleishman B, Crawford L, McKiernan T, Nesto RW. The multicenter study of enhanced external counterpulsation (MUST-EECP): effect of EECP on exercise-induced myocardial ischemia and anginal episodes. J Am Coll Cardiol. 1999;33:1833-1840.
  • Lawson WE, Hui JC, Lang G. Treatment benefit in the enhanced external counterpulsation consortium. Cardiology 2000; 94:31- 35.
  • Barsness G, Feldman AM, Holmes DR, Holubkov R, Kelsey SF, Kennard ED, Investigators TIEPR. The International EECP Patient Registry (IEPR): Design, methods, baseline characteristic, and acute results. Clin Cardiol. 2001;24:435-442.
  • PH Loh, JGF Cleland, AA Louis, ED Kennard, J Cook, JL Caplin, GW Barness, WE Lawson, OZ Soran, AD Michaels, for the IEPR Investigators. Enhanced external counterpulsation (EECP) in the treatment of chronic refractory angina: a long-term follow-up outcome from the International EECP Patient Registry (IEPR). Clin Cardiol. 2008;31(4):159-164.
  • Werner D, Schneider M, Weise M, et al. Pneumatic external counterpulsation: a new noninvasive method to improve organ perfusion. Am J Cardiol. 1999;84(8):950-952.
  • Michaels AD, Accad M, Ports TA, Grossman W. Left ventricular systolic unloading and augmentation of intracoronary pressure and Doppler flow during enhanced external counterpulsation. Circulation 2002;106:1237-1242.
  • Lawson WE, Barsness G, Michaels AD, Soran O, Kennard ED, Kelsey SF, Hui JC. Effectiveness of repeat enhanced external counterpulsation for refractory angina in patients failing to complete an initial course of therapy. Cardiology 2007;108:170-175.
  • Lawson WE. Current use of enhanced external counterpulsation and patient selection. Clin Cardiol. 2002;25:II16-21.
  • Mannheimer C, Camici P, Chester MR, Collins A, DeJongste M, Eliasson T, Follath F, Hellemans I, Herlitz J, Luscher T, Pasic M, Thelle D. The problem of chronic refractory angina; report from the ESC Joint Study Group on the Treatment of Refractory Angina. Eur Heart J. 2002;23:355-370. 
  • Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB, 3rd, Kligfield PD, Krumholz HM, Kwong RY, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR, Jr., Smith SC, Jr., Spertus JA, Williams SV. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2012;126:3097-3137.
  • Agrawal S, Mehta P.K., Bairey Merz C.N. Cardiac Syndrome X – Update 2014. Cardiol Clin. 2014 August;32(3):463–478.
  • Vermeltfoort IA, Raijmakers PG, Riphagen II, Odekerken DA, Kuijper AF, Zwijnenburg A, Teule GJ. Definitions and incidence of cardiac syndrome X: review and analysis of clinical data. Clin Res Cardiol. 2010 Aug;99(8):475-481.
  • Kronhaus KD, Lawson WE. Enhanced External Counterpulsation is an effective treatment for syndrome X. Int J Cardiol. 2009;135(2):256–257.