ECP treatment is evidence based and US FDA approved treatment in the following cardiac patients. The first group are patients who have already undergone a bypass surgery or an angioplasty and repeat procedures are not possible in this category The second group are patients who have been advised surgeries but are at very high risk and their heart pumping is low. ECP treatment can benefit them and make them better so that they are able to undergo surgeries. The third group are for the patients who are mentally not prepared to undergo the surgeries or they are stable with medical management and surgery later. This is also an important group, which can be benefited by the ECP treatment.
ECP treatment is very beneficial for the heart patients. Some key benefits of this procedure includes:
So naturally the patients is in a very good state of mind and body. There are no complications. With the ECP therapy, there is improvement in the symptoms of these patients, as the collateral network increases. The success rate of the ECP treatment over heart patients is more than 85%. Overall, ECP is a very beneficial therapy with almost none or a minimal side effect of the skin irritation due to the cuffs or a little backache, but it is very negligible.
When a patient undergoes an angiogram, the major coronary arteries are seen and block triple vessels are revealed where you can see the blockages of 70 to 90% in the major coronary arteries but in this angiogram the smaller vessels are not revealed. If we do a test known as a Thallium scan or a PET scan, we can assess the flow of blood through these collaterals also. So in ECP treatment, before and after studies of Stress Thallium or PET Scan has clearly demonstrated that there is an increase in collateral blood supply and there is increase in myocardial perfusion.
As the angiogram only depicts the structure of the artery of the heart the function of the heart can be measured by various tests. Treadmill test is a simple non-invasive cost effective test where if there is improvement in exercise tolerance it definitely means that there is an increase in the collateral blood supply. Apart from this there are other tests like Dobutamine Stress Echo where the patients lie down and echo report reveals that there is improvement in contractility of the heart muscles indirectly signifying that there is improvement in collateral network. The Thallium Scan and the PET Scan also shows increase in perfusion which again signifies that there is improvement in collateral network .
In ECP treatment, 35 sittings of one hour daily increase the collateral network. Life style changes are very important in each and every patient. Even if you look at coronary artery bypass surgery the grafts which are placed also can get re-blocked if the risk factors are not controlled. Similarly it has been proven that the efficacy of EECP treatment is for 3 to 5 years but we have done studies and noticed that if the patients follow the life style modifications where they are regular on their diet, give up smoking, do regular walks and if they are able to manage stress well along with the correct medicines, the re-currence is hardly 5%. So almost 95% patients do not have to repeat the therapy if life style changes are followed.
At Prashivyog we do a case selection for the ECP treatment. Every heart patient who approaches us for the treatment under goes thorough evaluation in terms of the symptoms, their investigations and their clinical examinations. There are certain cases where we cannot give ECP therapy. In cases where there is a severe leakage in the Aortic valve or there is aneurysm or there is a very severe peripheral vascular disease where we could not generate a counter pulse so these are the parameters we see. Sometimes the patients have a very severe spondylitis or a compressed disc and sciatica which can also hinder the treatment. There are relative contraindication like which can be corrected before giving the ECP like patient have got abnormally high blood pressure which can be controlled with medicines and given ECP later on. There are patients with irregular heartbeats or where !heir rhythm is not correct, we can medically manage them and give treatment. The bottom-line is that we care for every patient who comes to us and only administer the treatment to the patient who will be benefitted and not to the
patient who will be harmed.
International EECP registry at Pittsburg have documented almost 5022 cases for a period of 5 yrs and have noted that EECP therapy benefits for period of 3 – 5 yrs. Patients who do not follow the lifestyle changes there is 20 – 25 % re-occurrence. If the patients are following the lifestyle changes there-occurrence is almost nil or minimal.
ECP Treatment has been extensively researched and it has been concluded that it requires 35 hrs of the total treatment to induce effective collaterals network. I will just give you a similarity like for a child formation you require for a full term 9 months, similarly even in the heart there are big arteries and small arteries which you call the capillaries. To bring about the effective improvement in the collaterals a certain amount of counter pulsation has to be given on a daily consistent basis to bring about the significant effect. So 35 sittings is actually the minimum requirement. Many times patients who are having cardiac failure or having severe form of disease may even require more number of sittings. Since it is safe and non-invasive, it has alsogot a good repeat value. We have seen that patientswith low EF, often repeat once in a year or once in 3 yrs to control the disease better. So EECP is very safe effective and beneficial for the cardiac patients.
Getting a heart attack during the EECP therapy, because of the machine is not documented. In fact EECP treatment is US FDA approved for treatment in acute myocardial infarction. EECP itself does not induce a heart attack. We have done more than 1,00,000 cases of EECP treatment and there has not been a single death on table. If at all anything happens anywhere, it is just a rare case and is not due to the EECP machine or treatment.
EECP therapy is for 35 sittings 1 hr daily ona daycare basis. Every day the patient comes in for a period of 1 hour where this treatment is administered. Most of the time patient expects to know how soon one can see the improvement. This depends on case to case. We have seen that some patients feel very goodright from the 1st sitting, some fromthe 3rdsitting but on anaverage we have seen that majority of the patients start seeing the benefit after 1O – 12 sittings. Many times we have seen that patients who came on a wheel chair or noteven able to walk for 2 – 3 minutes, start walking better right form in the 1st sitting. Also in 3 to 5 sittings they are almost able to climb the 1st flight of stairs Now why this variation? Because the native collateral are different in different people , for example if like our hair some people have got thin hair, so similarly all of us may have a small collateral network or a big collateral network. We can’t see the way we can see our hair. So the response varies from person to person and that1s why we are talking of success rate of 85 % to 90 % because if there are not much adequate native collaterals even after EECP treatment the patient may not get the benefit but that number is very less. More than 90 % of the patients are benefitted symptom wise or in some way or the other because of this therapy.