Effects of enhanced external counterpulsation for patients with chronic heart failure: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

AERZIGU· Yakupu ¹ , XING Juan ¹ ,  AIKEBAIER· Anniwaer ²

1. Department of Cardiac Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, P. R. China;
2. Department of Thoracic Surgery, The Sixth People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830054, P. R. China;

Corresponding?author：

AIKEBAIER· Anniwaer, Email: 357649983@qq.com

Keywords：

Heart failure; enhanced external counterpulsation; quality of life; exercise ability; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202212024

Video：

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Objective To evaluate the effects of enhanced external counterpulsation (EECP) on exercise capacity and quality of life in patients with chronic heart failure. Methods PubMed, The Cochrane Library, EMbase, CNKI, Wanfang Data, VIP and CBM databases from January 1, 2010 to October 1, 2022 were searched by computer for the randomized controlled trial (RCT) about the intervention of EECP in patients with heart failure. Two researchers independently screened literature and extracted data. The meta-analysis was performed by RevMan 5.3. Results Nineteen RCTs were included. After EECP treatment, 6-minute walk distance (MD=57.37, 95%CI 40.89 to 70.85, P<0.001) and left ventricular ejection fraction improved (SMD=0.85, 95%CI 0.55 to 1.14, P<0.001). B-type natriuretic peptide decreased significantly (SMD=?0.67, 95%CI ?1.09 to ?0.25, P=0.002). The left ventricular end diastolic diameter (MD=?7.77, 95%CI ?11.49 to ?4.04, P<0.001), and the left ventricular end systolic diameter were significantly reduced (MD=?8.53, 95%CI ?13.47 to ?3.60, P<0.001). The quality of life of patients was improved (MD=16.34, 95%CI 0.59 to 32.10, P=0.04). Conclusion EECP can improve the exercise ability and the quality of life in patients with heart failure. However, more and larger well-designed RCTs are still needed to verify this conclusion.

Citation： AERZIGU· Yakupu, XING Juan, AIKEBAIER· Anniwaer. Effects of enhanced external counterpulsation for patients with chronic heart failure: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(10): 1531-1537. doi: 10.7507/1007-4848.202212024 Copy

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2.	World Health Organization. Cardiovascular diseases (CVDs). URL: https://apps.who.int/iris/handle/10665/274512.
3.	GBD 2017 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2018, 392(10159): 1859-1922.
4.	GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1204-1222.
5.	Arrigo M, Jessup M, Mullens W, et al. Acute heart failure. Nat Rev Dis Primers, 2020, 6(1): 16.
6.	Gerber Y, Weston SA, Redfield MM, et al. A contemporary appraisal of the heart failure epidemic in Olmsted County, Minnesota, 2000 to 2010. JAMA Intern Med, 2015, 175(6): 996-1004.
7.	Conrad N, Judge A, Tran J, et al. Temporal trends and patterns in heart failure incidence: A population-based study of 4 million individuals. Lancet, 2018, 391(10120): 572-580.
8.	Gohar A, Rutten FH, den Ruijter H, et al. Mid-regional pro-atrial natriuretic peptide for the early detection of non-acute heart failure. Eur J Heart Fail, 2019, 21(10): 1219-1227.
9.	Lin S, Wang XM, Wu GF. Expert consensus on the clinical application of enhanced external counterpulsation in elderly people (2019). Aging Med (Milton), 2020, 3(1): 16-24.
10.	劉凡, 李瑛, 王友麗, 等. 增強型體外反搏治療老年慢性收縮性心力衰竭的臨床觀察. 實用醫院臨床雜志, 2014, 11(4): 227-230.Liu F, Li Y, Wang YL, et al. Clinical observation of enhanced extracorporeal counterpulsation therapy for elderly patients with chronic systolic heart failure. Pract Hosp Clin J, 2014, 11(4): 227-230.
11.	Rampengan SH, Prihartono J, Siagian M, et al. The effect of enhanced external counterpulsation therapy and improvement of functional capacity in chronic heart failure patients: A randomized clinical trial. Acta Med Indones, 2015, 47: 275-282.
12.	李明臣, 李鍇. 增強型體外反搏治療老年慢性充血性心力衰竭的臨床研究. 中國冶金工業醫學雜志, 2017, 34(3): 255-256.Li MC, Li K. Clinical study on enhanced extracorporeal counterpulsation therapy for elderly patients with chronic congestive heart failure. Chin Med J Metall Ind, 2017, 34(3): 255-256.
13.	余意君, 劉濤, 鄒武松, 等. 體外反搏改善缺血性心力衰竭患者療效及無創心功能檢測指標. 重慶醫學, 2017, 46(31): 4360-4363, 4366.Yu YJ, Liu T, Zou WS, et al. External counterpulsation improves curative effect in patients with ischemic heart failure and noninvasive heart function detection indexes. Chongqing Med, 2017, 46(31): 4360-4363, 4366.
14.	Shashenko IV. Effects of the enhanced external counterpulsation therapy in patients with ischemic chronic heart failure. J Am Coll Cardiol, 2018, 72(16S): C164-C165.
15.	李金倍, 仝亞林. 增強型體外反搏治療缺血性心肌病心衰患者的效果. 河南醫學研究, 2018, 27(11): 1945-1946.Li JB, Tong YL. The effect of enhanced extracorporeal counterpulsation on patients with ischemic cardiomyopathy and heart failure. Henan Med Res, 2018, 27(11): 1945-1946.
16.	廖遠雄, 劉春濃, 李觀平, 等. 增強型體外反搏對射血分數中間范圍型心力衰竭患者活動耐量的影響. 嶺南急診醫學雜志, 2018, 23(3): 226-228.Liao YX, Liu CN, Li GP, et al. The effect of enhanced external counterpulsation on activity tolerance in patients with heart failure in the middle range of ejection fraction. Lingnan J Emerg Med, 2018, 23(3): 226-228.
17.	吳宇紅, 任強, 林如明, 等. 增強型體外反搏對慢性心力衰竭患者心功能指標的影響. 中華老年多器官疾病雜志, 2018, 17(3): 207-210.Wu YH, Ren Q, Lin RM, et al. The effect of enhanced external counterpulsation on cardiac function indicators in patients with chronic heart failure. Chin J Geriatr Mult Organ Dis, 2018, 17(3): 207-210.
18.	黃鑫, 趙佳佳, 樊俊雅, 等. 增強型體外反搏治療老年射血分數保留型心力衰竭的臨床療效. 實用醫學雜志, 2019, 35(23): 3633-3637.Huang X, Zhao JJ, Fan JY, et al. Clinical efficacy of enhanced extracorporeal counterpulsation in the treatment of elderly heart failure with preserved ejection fraction. Pract Med J, 2019, 35(23): 3633-3637.
19.	張華, 張雙, 鄭瑩, 等. 增強型體外反搏對缺血性心力衰竭患者心腎功能及內分泌系統的影響. 川北醫學院學報, 2019, 34(2): 276-279.Zhang H, Zhang S, Zhen Y, et al. The effect of enhanced external counterpulsation on cardiac and renal function and endocrine system in patients with ischemic heart failure. J North Sichuan Med Coll, 2019, 34(2): 276-279.
20.	李觀平, 廖遠雄. 增強型體外反搏對射血分數中間值心力衰竭患者心功能的影響. 中國心血管雜志, 2020, 25(4): 323-327.Li GP, Liao YX. Effect of enhanced external counter pulsation on cardiac function in heart failure patients withmidrange ejection fraction. Chin J Cardiovasc Med, 2020, 25(4): 323-327.
21.	蘇虹, 黃森, 邱小娥, 等. 體外反搏技術輔助治療慢性心力衰竭患者的臨床價值研究. 吉林醫學, 2020, 41(6): 1416-1418.Su H, Huang L, Qiu XE, et al. Clinical value of extracorporeal counterpulsation technology in assisting the treatment of chronic heart failure patients. Jilin Med J, 2020, 41(6): 1416-1418.
22.	王惠華, 余立平. EECP輔以心臟康復治療方案對心功能不全患者心功能及軀體癥狀的影響. 浙江臨床醫學, 2020, 22(4): 530-532.Wang HH, Yu LP. The effect of EECP combined with cardiac rehabilitation therapy on cardiac function and physical symptoms in patients with heart failure. Zhejiang Clin Med, 2020, 22(4): 530-532.
23.	張娥, 舒榮財, 譚慧, 等. 運動訓練配合EECP治療對COPD合并冠心病患者心肺功能及運動耐量的影響. 西部醫學, 2020, 32(8): 1193-1197.Zhang E, Shu RC, Tan H, et al. The effect of exercise training combined with EECP treatment on cardiopulmonary function and exercise tolerance in COPD patients with coronary heart disease. Med J West China, 2020, 32(8): 1193-1197.
24.	唐榮欣, 劉新燦, 李明, 等. 體外反搏對射血分數保留心力衰竭患者生存質量及預后的影響. 中國循證心血管醫學雜志, 2021, 13(5): 570-572.Tang RX, Liu XC, Li M, et al. Effect of external counterpulsation on quality of life and prognosis in patients with heart failure with preserved ejection fraction. Chin J Evid Based Cardiovasc Med, 2021, 13(5): 570-572.
25.	唐艷芳, 聶朝霞. 體外反搏對缺血性心力衰竭患者心功能及NT-proBNP水平的影響. 中國社區醫師, 2021, 37(21): 103-104.Tang YF, Nie ZX. Effects of ECP on cardiac function and NT-proBNP level in patients with ischemic heart failure. China Comm Doc, 2021, 37(21): 103-104.
26.	趙云, 劉瑾. 冠心病康復治療中增強型體外反搏的應用及對患者活動耐量與QOL評分的影響. 中國醫學創新, 2021, 18(9): 126-130.Zhao Y, Liu J. Application of enhanced external counterpulsation in rehabilitation treatment of coronary heart disease and its influence on activity tolerance and QOL score. Med Innov China, 2021, 18(9): 126-130.
27.	盧冬雪, 何琦. 增強型體外反搏治療冠心病伴心功能不全的療效. 上海醫藥, 2021, 42(19): 24-26.Lu DX, He Q. Effect of EECP in the treatment of coronary heart disease with cardiac insufficiency. Shanghai Med J, 2021, 42(19): 24-26.
28.	申文宇, 馮文化, 王海洋, 等. 體外反搏治療老年肌少癥合并慢性心力衰竭的臨床療效觀察. 中西醫結合心腦血管病雜志, 2021, 19(15): 2669-2671.Shen WY, Feng WH, Wang HY, et al. Observation of the clinical efficacy of extracorporeal counterpulsation in the treatment of elderly patients with sarcopenia and chronic heart failure. Chin J Integr Med Cardio-Cerebro Vasc Dis, 2021, 19(15): 2669-2671.
29.	Du J, Wu G, Wu B, et al. The hemodynamic effect of enhanced external counterpulsation treatment on atherosclerotic plaque in the carotid artery: A framework of patient-specific computational fluid dynamics analysis. Cardiol Res Pract, 2020, 2020: 5903790.
30.	Hadi NR, Shaker SR, Fedacko J. Enhanced external counterpulsation: Current practices and future directions. B P International, 2021.
31.	Wu E, Desta L, Brostr?m A, et al. Effectiveness of enhanced external counterpulsation treatment on symptom burden, medication profile, physical capacity, cardiac anxiety, and health-related quality of life in patients with refractory angina pectoris. J Cardiovasc Nurs, 2020, 35(4): 375-385.
32.	Subramanian R, Ahmed S, Chokkalingam M. Efficacy of enhanced external counter pulsation in improving six minutes’ walk test in heart failure patients. Biomedicine, 2022, 42: 274-279.
33.	Sarah CK, Silver M, Puri S. Enhanced external counterpulsation Improves functional capacity in a cohort with heart failure with preserved ejection fraction. J Am Coll Cardiol, 2019, 73(9S1): 834.
34.	Wu E, M?rtensson J, Desta L, et al. Predictors of treatment benefits after enhanced external counterpulsation in patients with refractory angina pectoris. Clin Cardiol, 2021, 44(2): 160-167.
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1. Park JJ, Choi DJ. Current status of heart failure: Global and Korea. Korean J Intern Med, 2020, 35(3): 487-497.
2. World Health Organization. Cardiovascular diseases (CVDs). URL: https://apps.who.int/iris/handle/10665/274512.
3. GBD 2017 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2018, 392(10159): 1859-1922.
4. GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1204-1222.
5. Arrigo M, Jessup M, Mullens W, et al. Acute heart failure. Nat Rev Dis Primers, 2020, 6(1): 16.
6. Gerber Y, Weston SA, Redfield MM, et al. A contemporary appraisal of the heart failure epidemic in Olmsted County, Minnesota, 2000 to 2010. JAMA Intern Med, 2015, 175(6): 996-1004.
7. Conrad N, Judge A, Tran J, et al. Temporal trends and patterns in heart failure incidence: A population-based study of 4 million individuals. Lancet, 2018, 391(10120): 572-580.
8. Gohar A, Rutten FH, den Ruijter H, et al. Mid-regional pro-atrial natriuretic peptide for the early detection of non-acute heart failure. Eur J Heart Fail, 2019, 21(10): 1219-1227.
9. Lin S, Wang XM, Wu GF. Expert consensus on the clinical application of enhanced external counterpulsation in elderly people (2019). Aging Med (Milton), 2020, 3(1): 16-24.
10. 劉凡, 李瑛, 王友麗, 等. 增強型體外反搏治療老年慢性收縮性心力衰竭的臨床觀察. 實用醫院臨床雜志, 2014, 11(4): 227-230.Liu F, Li Y, Wang YL, et al. Clinical observation of enhanced extracorporeal counterpulsation therapy for elderly patients with chronic systolic heart failure. Pract Hosp Clin J, 2014, 11(4): 227-230.
11. Rampengan SH, Prihartono J, Siagian M, et al. The effect of enhanced external counterpulsation therapy and improvement of functional capacity in chronic heart failure patients: A randomized clinical trial. Acta Med Indones, 2015, 47: 275-282.
12. 李明臣, 李鍇. 增強型體外反搏治療老年慢性充血性心力衰竭的臨床研究. 中國冶金工業醫學雜志, 2017, 34(3): 255-256.Li MC, Li K. Clinical study on enhanced extracorporeal counterpulsation therapy for elderly patients with chronic congestive heart failure. Chin Med J Metall Ind, 2017, 34(3): 255-256.
13. 余意君, 劉濤, 鄒武松, 等. 體外反搏改善缺血性心力衰竭患者療效及無創心功能檢測指標. 重慶醫學, 2017, 46(31): 4360-4363, 4366.Yu YJ, Liu T, Zou WS, et al. External counterpulsation improves curative effect in patients with ischemic heart failure and noninvasive heart function detection indexes. Chongqing Med, 2017, 46(31): 4360-4363, 4366.
14. Shashenko IV. Effects of the enhanced external counterpulsation therapy in patients with ischemic chronic heart failure. J Am Coll Cardiol, 2018, 72(16S): C164-C165.
15. 李金倍, 仝亞林. 增強型體外反搏治療缺血性心肌病心衰患者的效果. 河南醫學研究, 2018, 27(11): 1945-1946.Li JB, Tong YL. The effect of enhanced extracorporeal counterpulsation on patients with ischemic cardiomyopathy and heart failure. Henan Med Res, 2018, 27(11): 1945-1946.
16. 廖遠雄, 劉春濃, 李觀平, 等. 增強型體外反搏對射血分數中間范圍型心力衰竭患者活動耐量的影響. 嶺南急診醫學雜志, 2018, 23(3): 226-228.Liao YX, Liu CN, Li GP, et al. The effect of enhanced external counterpulsation on activity tolerance in patients with heart failure in the middle range of ejection fraction. Lingnan J Emerg Med, 2018, 23(3): 226-228.
17. 吳宇紅, 任強, 林如明, 等. 增強型體外反搏對慢性心力衰竭患者心功能指標的影響. 中華老年多器官疾病雜志, 2018, 17(3): 207-210.Wu YH, Ren Q, Lin RM, et al. The effect of enhanced external counterpulsation on cardiac function indicators in patients with chronic heart failure. Chin J Geriatr Mult Organ Dis, 2018, 17(3): 207-210.
18. 黃鑫, 趙佳佳, 樊俊雅, 等. 增強型體外反搏治療老年射血分數保留型心力衰竭的臨床療效. 實用醫學雜志, 2019, 35(23): 3633-3637.Huang X, Zhao JJ, Fan JY, et al. Clinical efficacy of enhanced extracorporeal counterpulsation in the treatment of elderly heart failure with preserved ejection fraction. Pract Med J, 2019, 35(23): 3633-3637.
19. 張華, 張雙, 鄭瑩, 等. 增強型體外反搏對缺血性心力衰竭患者心腎功能及內分泌系統的影響. 川北醫學院學報, 2019, 34(2): 276-279.Zhang H, Zhang S, Zhen Y, et al. The effect of enhanced external counterpulsation on cardiac and renal function and endocrine system in patients with ischemic heart failure. J North Sichuan Med Coll, 2019, 34(2): 276-279.
20. 李觀平, 廖遠雄. 增強型體外反搏對射血分數中間值心力衰竭患者心功能的影響. 中國心血管雜志, 2020, 25(4): 323-327.Li GP, Liao YX. Effect of enhanced external counter pulsation on cardiac function in heart failure patients withmidrange ejection fraction. Chin J Cardiovasc Med, 2020, 25(4): 323-327.
21. 蘇虹, 黃森, 邱小娥, 等. 體外反搏技術輔助治療慢性心力衰竭患者的臨床價值研究. 吉林醫學, 2020, 41(6): 1416-1418.Su H, Huang L, Qiu XE, et al. Clinical value of extracorporeal counterpulsation technology in assisting the treatment of chronic heart failure patients. Jilin Med J, 2020, 41(6): 1416-1418.
22. 王惠華, 余立平. EECP輔以心臟康復治療方案對心功能不全患者心功能及軀體癥狀的影響. 浙江臨床醫學, 2020, 22(4): 530-532.Wang HH, Yu LP. The effect of EECP combined with cardiac rehabilitation therapy on cardiac function and physical symptoms in patients with heart failure. Zhejiang Clin Med, 2020, 22(4): 530-532.
23. 張娥, 舒榮財, 譚慧, 等. 運動訓練配合EECP治療對COPD合并冠心病患者心肺功能及運動耐量的影響. 西部醫學, 2020, 32(8): 1193-1197.Zhang E, Shu RC, Tan H, et al. The effect of exercise training combined with EECP treatment on cardiopulmonary function and exercise tolerance in COPD patients with coronary heart disease. Med J West China, 2020, 32(8): 1193-1197.
24. 唐榮欣, 劉新燦, 李明, 等. 體外反搏對射血分數保留心力衰竭患者生存質量及預后的影響. 中國循證心血管醫學雜志, 2021, 13(5): 570-572.Tang RX, Liu XC, Li M, et al. Effect of external counterpulsation on quality of life and prognosis in patients with heart failure with preserved ejection fraction. Chin J Evid Based Cardiovasc Med, 2021, 13(5): 570-572.
25. 唐艷芳, 聶朝霞. 體外反搏對缺血性心力衰竭患者心功能及NT-proBNP水平的影響. 中國社區醫師, 2021, 37(21): 103-104.Tang YF, Nie ZX. Effects of ECP on cardiac function and NT-proBNP level in patients with ischemic heart failure. China Comm Doc, 2021, 37(21): 103-104.
26. 趙云, 劉瑾. 冠心病康復治療中增強型體外反搏的應用及對患者活動耐量與QOL評分的影響. 中國醫學創新, 2021, 18(9): 126-130.Zhao Y, Liu J. Application of enhanced external counterpulsation in rehabilitation treatment of coronary heart disease and its influence on activity tolerance and QOL score. Med Innov China, 2021, 18(9): 126-130.
27. 盧冬雪, 何琦. 增強型體外反搏治療冠心病伴心功能不全的療效. 上海醫藥, 2021, 42(19): 24-26.Lu DX, He Q. Effect of EECP in the treatment of coronary heart disease with cardiac insufficiency. Shanghai Med J, 2021, 42(19): 24-26.
28. 申文宇, 馮文化, 王海洋, 等. 體外反搏治療老年肌少癥合并慢性心力衰竭的臨床療效觀察. 中西醫結合心腦血管病雜志, 2021, 19(15): 2669-2671.Shen WY, Feng WH, Wang HY, et al. Observation of the clinical efficacy of extracorporeal counterpulsation in the treatment of elderly patients with sarcopenia and chronic heart failure. Chin J Integr Med Cardio-Cerebro Vasc Dis, 2021, 19(15): 2669-2671.
29. Du J, Wu G, Wu B, et al. The hemodynamic effect of enhanced external counterpulsation treatment on atherosclerotic plaque in the carotid artery: A framework of patient-specific computational fluid dynamics analysis. Cardiol Res Pract, 2020, 2020: 5903790.
30. Hadi NR, Shaker SR, Fedacko J. Enhanced external counterpulsation: Current practices and future directions. B P International, 2021.
31. Wu E, Desta L, Brostr?m A, et al. Effectiveness of enhanced external counterpulsation treatment on symptom burden, medication profile, physical capacity, cardiac anxiety, and health-related quality of life in patients with refractory angina pectoris. J Cardiovasc Nurs, 2020, 35(4): 375-385.
32. Subramanian R, Ahmed S, Chokkalingam M. Efficacy of enhanced external counter pulsation in improving six minutes’ walk test in heart failure patients. Biomedicine, 2022, 42: 274-279.
33. Sarah CK, Silver M, Puri S. Enhanced external counterpulsation Improves functional capacity in a cohort with heart failure with preserved ejection fraction. J Am Coll Cardiol, 2019, 73(9S1): 834.
34. Wu E, M?rtensson J, Desta L, et al. Predictors of treatment benefits after enhanced external counterpulsation in patients with refractory angina pectoris. Clin Cardiol, 2021, 44(2): 160-167.
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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effects of enhanced external counterpulsation for patients with chronic heart failure: A systematic review and meta-analysis

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