Enhanced External Counterpulsation

TI model
T model

TM model
Paediatric Type for children

EECP-Enhanced External Counterpulsation is an FDA-approved, non-invasive, non-surgical and outpatient medical therapy for the treatment of angina, congestive heart failure, acute myocardial infarction, and cardiogenic shock. During the treatment, blood pressure cuffs, wrapped around your legs, squeezed and released in sync with your heartbeat, promoting blood flow throughout your body and particularly to your heart. In the process, EECP develops new pathways around blocked arteries in the heart by expanding networks of tiny blood vessels ("collaterals") that help increase and normalize blood flow to the heart muscle. For this reason, it is often called the NATURAL BYPASS.
Numerous clinical trials have shown EECP therapy to be safe and effective for patients with refractory angina with a clinical response rate averaging 70-80%, which is sustained up to five years.
What is EECP ?

EECP therapy consists of a system of three sets of inflation pressure cuffs wrapped around the calves, thighs and hips and then rapidly inflated and deflated in sync with the patient’s heartbeat. Using a heart monitor, the cuffs sequentially inflate with air when the heart relaxes and deflate when the heart pumps. The timing of the inflation and deflation makes it easier for the heart to pump and increases blood supply to the heart. Studies show that 75% of patients treated with a single course of EECP experience a reduction in their angina and increased exercise tolerance.
What does EECP do?

EECP Principles of Operation
Systolic Deflation
Simultaneously deflate all three sets of cuffs at the end of diastole
Systolic Unloading
Reduce Cardiac Workload
Increase Cardiac Output
Lower Thigh Cuffs
Upper Thigh Cuffs
Calf Cuffs
Diastolic Augmentation
Increase
Coronary Perfusion
Increase
Cardiac Output
Diastolic Inflation
Sequential inflate three sets of cuffs at the end of systole
Increase
Venous return
ECG
Normal
EECP
Lower Thigh Cuffs
Upper Thigh Cuffs
Calf Cuffs

Myocardial Energy Demand and Supply
Time Tension Index
Workload of the heart is related to myocardial oxygen consumption
Diastolic Pressure Time Index
Energy supply to the myocardium in proportion to coronary perfusion pressure
Normal
During Counterpulsation
Systolic Unloading
Diastolic
Augmentation

Benefit of EECP
Angina
Angioplasty (PTCA) or Bypass surgery (CABG).
CAD – Coronary Artery Disease
CHD – Coronary Heart Disease
PVD – Peripheral Vascular Disease
ED – Erectile Dysfunction
Cardiac chest pain
Congestive heart failure
Peripheral vascular disease
Cardiomyopathy
Peripheral neuropathy
cerebral palsy
Intestinal vascular insufficiency
Edema, or venous insufficiency
Chronic fatigue syndrome
Other benefits:
Stroke
kidney disease
Parkinson’s disease
Memory disorders
Diabetes and Diabetic Neuropathy
High blood pressure
Macular degeneration
Other circulatory diseases
hearing loss and tinnitus
vision impairment
autoimmune diseases (including Raynaud’s phenomenon)
rheumatic disease
restless leg syndrome.
Lymphatic System
Sports Enhancement
Anti-aging

Arrhythmias that interfere with machine triggering (need rate controlling)
Bleeding diathesis (INR must be < 2.5)
Active thrombophlebitis
Severe lower extremity peripheral vascular disease
Presence of a documented aortic aneurysm requiring surgical repair
Pregnancy
CONTRAINDICATIONS
PRECAUTIONS
Patients with blood pressure higher than 180/110 mmHg should be controlled prior to treatment.
Patients with a heart rate of more than 120 bpm should be controlled prior to treatment.
Patients at high risk of complications from increased venous return should be carefully chosen and monitored during treatment. Decreasing cardiac afterload by optimizing cuff inflation and deflation timing may help minimize increased cardiac filling pressures and the possibility of pulmonary congestion due to increased venous return.
Patients with clinically significant valvular disease should be carefully chosen and monitored during treatment with enhanced external counterpulsation. Certain valve conditions, such as significant aortic insufficiency or severe mitral or aortic stenosis, may prevent the patient from obtaining benefit from diastolic augmentation and reduced cardiac afterload in the presence of increased venous return.

EECP Treatment Regimen
Standard Treatment Time
5 daily 1 hour treatments per week over 7 weeks for a total of 35 hours or
2 x 1 hours daily over 3½ weeks for 35 hours total
Extension
7% from IEPR-2 had extended their 35 hours by 10.3 ± 9.8 hours because of persistent angina (67%), patient’s preference (41%), physician’s (40%)
Extension is safe and patients continued to benefits with significant incremental improvement in symptoms and functional class
Repeat Therapy
18% of the patients having completed their initial course of 35 hours of EECP undergo retreatment within 2 years
Common reasons for retreatment are recurrent angina, persistent angina
About 13% of the patients failed to complete their initial 35 hours course of EECP because of patient’s choice and adverse clinical events
30% of those who failed returned within 1 year for retreatment
At retreatment, patients realized a benefit similar to patients who respond to a first course, with 70% improved by at least one CCS angina class, decreased angina episodes and nitroglycerin use.

How do I personally know EECP treatment has helped me?
Patient can walk more distance without chest pain
Patient would have fewer or no angina
Episodes of angina would be less painful
Patient can return to work and can participate in their active life style once again
Patient would be more energetic and confidence.
Are there any risks or side effects of EECP?
EECP is safe. Occasionally, some patients experience mild skin irritation under the areas of the blood pressure cuffs. Experienced EECP therapists address this irritation by using extra padding to make the patient comfortable. Some patients experience a bit more fatigue at the beginning of their course of treatment, but it usually subsides after the first few sessions. In fact, patients typically feel energized by EECP.
How does EECP compare to angioplasty or bypass surgery?
The five-year outcomes for EECP patients are virtually the same as for angioplasty and bypass surgery patients.
F.A.Q.

What are advantages of EECP?
EECP is non-invasive, simple, safe, risk-free and cost effective treatment without surgery or hospital stay. Patient can take this treatment without disturbing his/her daily routine life.
Is EECP possible after angioplasty or bypass surgery?
Yes, When the symptoms recurs or where the results of these procedures are inadequate or for additional benefit for a better and more active lifestyle.
Long term benefits
Data from the International EECP Patient Registry (IEPR) by the University of Pittsburgh’s Graduate school of Public Health, USA suggest that the reduction in angina following EECP treatment is frequently sustained for up to 2 years post treatment. Patient follows up in many studies suggest that benefits of EECP persist for up to 5 years or more.

PRE EECP POST EECP
Very dark due to reduced blood flow Extremely bright due to all of the new vessels
feeding the heart
EECP helps grow new collaterals for blood to flow, like a natural bypass around blocked arteries.

Clinical Evidence
Summary:
After 24 months follow up 31% of patients recorded being angina free compared to 0% at the start of the study.
82% of patients improved after EECP by one or more CCS class
43.9% of patients improved after EECP by two or more CCS classes
Benefits were sustain over the 24 month follow up.
The International EECP Patient Registry (IEPR) has provided data on over 5,000 patients demonstrating therapeutic outcomes and duration of benefit.
Functional scores were graded using CCS angina score - classes I (mild) to IV (severe).

Visible evidence of hemodynamic effect on actual EECP patient
Systolic unloading reduces energy requirements of the heart
Dramatic diastolic augmentation (equal to or greater than intraaortic balloon pump)
Increased retrograde diastolic and enhanced systolic flow
Doppler echo of the descending aorta during EECP treatment

Problems in Treating Heart Failure
As the society aging, and the mortality rate from patients suffering from myocardial infarction decreases, the number of patients with heart failure will increase at a much faster pace, placing much more stress on the healthcare system
Currently there is no effective therapy for heart failure
The mortality rate for heart failure remain high (2001: 53,000 death/year)
The difficulty in defining heart failure is because it is not a single organ disease but a systemic disease
We require a treatment that not only improve the cardiac function but provide systemic pathophysiological benefits

Treatment of Heart Failure
Objectives:
Symptomatic Improvement
Preventing transition of asymptomatic cardiac dysfubction to symptomatic HF
Preventing worsening of symptoms and/or functional limitations of HF
Reducing ER visits and hosppitalizations
Reducing mortality
Pharmacilogical therapy:
Prevention – hypertension, diabetes and underlying causes
Device:
Enhanced External Counterpulsation (EECP)
Pacemaker
Implantable cardioverter defibrilator in pts with ventriculat tachycardia or ventricular fibrillation
Ventricular assist device / Artifical heart
Utrafiltration
Cardiac Resynchronization therapy; ptrs with abnormal conduction

EECP Improves Each Major Pathophysiologic Feature of Heart Failure
Decrease Cardiac output
Sympathetic Nervous
System Activation
Myocardial Injury
CAD, Structural
Endothelial Dysfunction
Neurohormonal Activation
RAAS, endothelin
Heart Failure
Hypertrophy, fibrosis
EECP improves coronary perfusion
EECP increases SV and CO
EECP improves
Endothelial cell function
EECP increases contractility
EECP decreases plasma and tissue Renin, Ang II
EECP improves exercise capacity, QoL

Hemodynamics of the Heart
Flow =
Pressure
Resistance
Energy balance
Supply: Diastolic Pressure Time
Demand: Systolic Pressure Time
Aortic Pressure
ECG
Left Ventricular Pressure
Coronary artery blood flow
Stroke Volume
150
100
50
Blood Pressure (mm Hg)
0
Systole
Diastole
5
0
Blood flow (L/min)
Blood flow (ml/min)

Diastolic aortic root blood flow increased
Increase CO
Increase the Intravenous blood
Increase Systolic blood of the heart
Systolic
Diastolic
Reduce systolic
resistance
Increase coronary blood
The positive influence to blood circulation by EECP

EECP TREATMENT CAN ALSO BE USED FOR PREVENTIVE PURPOSES
Patients who had successful balloon-stent application and/or bypass operation because of significant narrowings in their coronary arteries and are asymptomatic but are candidate for early re-stenosis and occlusions due to having
small coronary arteries (as mostly seen in diabetic and woman), should receive EECP therapy, in order to prolong the asymptomatic period provided by these interventions.
Patients with coronary artery disease who have no symptoms but have mild or moderate narrowings in their coronary arteries, and also patients who have no documented coronary artery disease but have strong family history and many risk factors and therefore candidate for coronary artery disease, can get benefit from EECP’s preventive effects.
In summary, EECP is a useful treatment for every stage of coronary artery disease beginning from the presence of risk factors without documented disease to the advanced stage of the disease with severe symptoms refractory to other treatment modalities.

P-ECP/TI（All-in-One Touch screen type）
P-ECP/TI（All-in-One Laptop type）
EECP
Safest, Non-surgical, FDA approved.

Characteristics:
Passed by CE certificate and Bio-compatibility test.
It is based on Modern Medicine, Bio-Clinic Medicine, and Scientific Precise Data.
It adopts the latest computer, modern control technique, and software control system.
It adopts Germany Air Compressor and electromagnetic value only for EECP with proprietary intellectual property rights.
It adopts scientific designed system to reduce noise and heat.
It adopts integration of equipment (All in One) design.
Its shape is based on the ergonomic design.
Transport and Storage Environment
Temperature 14 to 104 (-10°C to 40°C)
Relative Humidity ≤80%
Atmospheric Pressure 0.1013MPa Atmospheric Free of corrosive gas
Dimension and Weight
L*W*H 2150mm×840mm×600mm
Net Weight 178 kg
Power Requirement
AC Single Phrase:220V±22V 50Hz/60Hz
Maximum Power: 2.6KVA

Model: P-ECP/T (split type)

Characteristics:
Design of air compressor and treatment bed separately, the air compressor comes with soundproof, place the air compressor and treatment bed in different rooms to make the patient completely free from noise impact during treatment;
Transport and Storage Environment
Temperature 14 to 104 (-10°Cto 40°C)
Relative Humidity ≤80%
Atmospheric Pressure 0.1013MPa
Atmospheric Free of corrosive gas
Dimension and Weight
Treatment Bed L×W×H 1980mm×800mm×700mm
Net Weight 117kg
Soundproof Box (Including Air compressor) L×W×H 720mm×600mm×730mm
Net Weight 75kg
Bedside Desk L×W×H 500mm×400mm×680mm
Net Weight 18kg
Power Requirement
AC Single Phrase:220V±22V 50Hz/60Hz
Maximum Power: 2.6KVA

Model: P-ECP/TM (Movable type)

Transport and Storage Environment
Temperature 14 to 104 (-10°C to 40°C)
Relative Humidity ≤80%
Atmospheric Pressure 0.1013MPa Atmospheric Free of corrosive gas
Dimension and Weight
L×W×H 780mm×515mm×960mm
Net Weight 121kg
Power Requirement
AC Single Phrase:220V±22V 50Hz/60Hz
Maximum Power: 2.6KVA
Characteristics:
It is movable type with small space which make the treatment more easily.
The air compressor adopted in the machine is Becker sliding vane rotary vacuum pump which is made in Germany and is full of gas, low noise and light.
All the indexes of boxes of product have passed the CE Certificated and the test of bio-compatibility.
It adopts the electromagnetic value with independent intellectual property rights, and the characteristic of inflation and deflation are more excellent.
It adopts special noise reduction and heat dissipation system.

Split Model: Pediatric Type for children

Characteristics:
CE approval and passed biocompatibility tests;
Based on modern medicine, bio-clinical medicine, high-precision scientific data;
Professional design in accordance with the characteristics of children such as the size, appearance, comfort;
Bladder design specifically for Children to prevent from all kinds of circuit malfunction;
Scientific design of cooling, noise reduction system;
Design of air compressor and treatment bed separately, the air compressor comes with soundproof, place the air compressor and treatment bed in different rooms to make the patient completely free from noise impact during treatment;
Treatment Bed
L×W×H: 1600mm×710mm×610mm
Soundproof Box (including air compressor)
L×W×H: 720mm×600mm×730mm
Net weight: 75kg
Bedside Desk
L×W×H: 500mm×400mm×680mm
Net weight: 18kg

Media reports about Enhanced External Counterpulsation
Bypassing the surgeon(不需要外科的“心脏搭桥”！)

Clinical research

Technical Cooperation And Exchanges
Our CEO in the First Academic Exchange Conference of EECP
Prof Zheng zhensheng(middle, The father of EECP) and our CEOs
Prof Cai Dawei(middle, the author of External Counterpulsation) and CEOs
Association of cardiovascular club President Prof Fu dayi and our CEO
EECP experts Prof. William Lawson
JHui Ph.D John Hui and our CEO

EECP users

PSK EECP WORLDWIDE
Philippines
Malaysia
Singapore
China
USA
UAE
New Zealand
Russia
South Africa
Iran
Guatemala
Lebanon
India
Panama
Hong Kong
Thailand
Bangladesh
Germany
Indonesia
In the foreign market, we exported to more than 20 countries. Established 3 branch offices: India, Bangladesh, Thailand.
Korea
Azerbaijan
Iraq
Turkey
Australia
Clombia

American College of Cardiology (ACC) / American Heart Association (AHA) (2002), European Society of Cardiology (ESC) (2006) and Chinese Cardiovascular Society(2006) all put ECP therapy into the guidelines for treatment of angina pectoris and coronary heart disease.

2009-7 Chongqing
EECP Association China (MCA)
The 2nd International EECP Symposium

Launch of the International EECP
The International EECP Society (IEECPS) was created in October 2013 as an association of physicians and clinicians involved in the study, research, application and provision of Enhanced External Counterpulsation (EECP) Therapy. Enhanced External Counterpulsation (EECP)Therapy, is an FDA-cleared, non-invasive, treatment for the symptoms of cardiovascular diseases stable ischemic heart disease, angina and congestive heart failure and other. Clinical studies in over 160 published medical and scientific journal articles on the safety and efficacy of EECP therapy have demonstrated that EECP therapy eliminates or significantly reduces symptoms while also improving the quality of life for these patients. Follow up studies have shown these initial benefits to be maintained for 3-5 years. EECP therapy is covered by Medicare and most third-party payers in the U.S. and many countries globally.
The mission of the IEECPS is to promote excellence in the noninvasive treatment of cardiovascular diseases through physician education, research, increased patient awareness, representation, and the advancement of quality patient care with EECP therapy.

PSK Exclusive Sponsors
The 3rd International EECP Symposium

The 3rd International EECP Symposium