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.	刘凡, 李瑛, 王友丽, 等. 增强型体外反搏治疗老年慢性收缩性心力衰竭的临床观察. 实用医院临床杂志, 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, 李锴. 增强型体外反搏治疗老年慢性充血性心力衰竭的临床研究. 中国冶金工业医学杂志, 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, 刘涛, 邹武松, 等. 体外反搏改善缺血性心力衰竭患者疗效及无创心功能检测指标. 重庆医学, 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, 仝亚林. 增强型体外反搏治疗缺血性心肌病心衰患者的效果. 河南医学研究, 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.	廖远雄, 刘春浓, 李观平, 等. 增强型体外反搏对射血分数中间范围型心力衰竭患者活动耐量的影响. 岭南急诊医学杂志, 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.	吴宇红, 任强, 林如明, 等. 增强型体外反搏对慢性心力衰竭患者心功能指标的影响. 中华老年多器官疾病杂志, 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.	黄鑫, 赵佳佳, 樊俊雅, 等. 增强型体外反搏治疗老年射血分数保留型心力衰竭的临床疗效. 实用医学杂志, 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.	张华, 张双, 郑莹, 等. 增强型体外反搏对缺血性心力衰竭患者心肾功能及内分泌系统的影响. 川北医学院学报, 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.	李观平, 廖远雄. 增强型体外反搏对射血分数中间值心力衰竭患者心功能的影响. 中国心血管杂志, 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.	苏虹, 黄森, 邱小娥, 等. 体外反搏技术辅助治疗慢性心力衰竭患者的临床价值研究. 吉林医学, 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.	王惠华, 余立平. EECP辅以心脏康复治疗方案对心功能不全患者心功能及躯体症状的影响. 浙江临床医学, 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.	张娥, 舒荣财, 谭慧, 等. 运动训练配合EECP治疗对COPD合并冠心病患者心肺功能及运动耐量的影响. 西部医学, 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.	唐荣欣, 刘新灿, 李明, 等. 体外反搏对射血分数保留心力衰竭患者生存质量及预后的影响. 中国循证心血管医学杂志, 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.	唐艳芳, 聂朝霞. 体外反搏对缺血性心力衰竭患者心功能及NT-proBNP水平的影响. 中国社区医师, 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.	赵云, 刘瑾. 冠心病康复治疗中增强型体外反搏的应用及对患者活动耐量与QOL评分的影响. 中国医学创新, 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.	卢冬雪, 何琦. 增强型体外反搏治疗冠心病伴心功能不全的疗效. 上海医药, 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, 冯文化, 王海洋, 等. 体外反搏治疗老年肌少症合并慢性心力衰竭的临床疗效观察. 中西医结合心脑血管病杂志, 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, Broström 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, Mårtensson 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.
35.	Kusuma DY, Shatri H, Alwi I, et al. Validity and reliability studies of the indonesian version of the minnesota living with heart failure questionnaire (MLHFQ): Quality of life questionnaire for patients with chronic heart failure. Acta Med Indones, 2019, 51(1): 26-33.
36.	Moradi M, Daneshi F, Behzadmehr R, et al. Quality of life of chronic heart failure patients: A systematic review and meta-analysis. Heart Fail Rev, 2020, 25(6): 993-1006.
37.	王伟玲, 高海青, 刘相菊, 等. 增强型体外反搏治疗对老年射血分数保留心力衰竭患者的疗效. 中华老年医学杂志, 2021, 40(3): 288-291.Wang WL, Gao HQ, Liu XJ, et al. The effect of enhanced external counterpulsation on heart failure with preserved ejection fraction in the elderly. Chin J Geriatr, 2021, 40(3): 288-291.
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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. 刘凡, 李瑛, 王友丽, 等. 增强型体外反搏治疗老年慢性收缩性心力衰竭的临床观察. 实用医院临床杂志, 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, 李锴. 增强型体外反搏治疗老年慢性充血性心力衰竭的临床研究. 中国冶金工业医学杂志, 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, 刘涛, 邹武松, 等. 体外反搏改善缺血性心力衰竭患者疗效及无创心功能检测指标. 重庆医学, 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, 仝亚林. 增强型体外反搏治疗缺血性心肌病心衰患者的效果. 河南医学研究, 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. 廖远雄, 刘春浓, 李观平, 等. 增强型体外反搏对射血分数中间范围型心力衰竭患者活动耐量的影响. 岭南急诊医学杂志, 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. 吴宇红, 任强, 林如明, 等. 增强型体外反搏对慢性心力衰竭患者心功能指标的影响. 中华老年多器官疾病杂志, 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. 黄鑫, 赵佳佳, 樊俊雅, 等. 增强型体外反搏治疗老年射血分数保留型心力衰竭的临床疗效. 实用医学杂志, 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. 张华, 张双, 郑莹, 等. 增强型体外反搏对缺血性心力衰竭患者心肾功能及内分泌系统的影响. 川北医学院学报, 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. 李观平, 廖远雄. 增强型体外反搏对射血分数中间值心力衰竭患者心功能的影响. 中国心血管杂志, 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. 苏虹, 黄森, 邱小娥, 等. 体外反搏技术辅助治疗慢性心力衰竭患者的临床价值研究. 吉林医学, 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. 王惠华, 余立平. EECP辅以心脏康复治疗方案对心功能不全患者心功能及躯体症状的影响. 浙江临床医学, 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. 张娥, 舒荣财, 谭慧, 等. 运动训练配合EECP治疗对COPD合并冠心病患者心肺功能及运动耐量的影响. 西部医学, 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. 唐荣欣, 刘新灿, 李明, 等. 体外反搏对射血分数保留心力衰竭患者生存质量及预后的影响. 中国循证心血管医学杂志, 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. 唐艳芳, 聂朝霞. 体外反搏对缺血性心力衰竭患者心功能及NT-proBNP水平的影响. 中国社区医师, 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. 赵云, 刘瑾. 冠心病康复治疗中增强型体外反搏的应用及对患者活动耐量与QOL评分的影响. 中国医学创新, 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. 卢冬雪, 何琦. 增强型体外反搏治疗冠心病伴心功能不全的疗效. 上海医药, 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, 冯文化, 王海洋, 等. 体外反搏治疗老年肌少症合并慢性心力衰竭的临床疗效观察. 中西医结合心脑血管病杂志, 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, Broström 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, Mårtensson 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.
35. Kusuma DY, Shatri H, Alwi I, et al. Validity and reliability studies of the indonesian version of the minnesota living with heart failure questionnaire (MLHFQ): Quality of life questionnaire for patients with chronic heart failure. Acta Med Indones, 2019, 51(1): 26-33.
36. Moradi M, Daneshi F, Behzadmehr R, et al. Quality of life of chronic heart failure patients: A systematic review and meta-analysis. Heart Fail Rev, 2020, 25(6): 993-1006.
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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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