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Medical Research

Clinical Studies

Click on the links below to view the clinical studies.

Cardiovascular Disease

  1. Ashokprabhu, N. D., Fox, J., Henry, T. D., Schmidt, C. W., Tierney, D., Gallatin, J., Alvarez, Y. R., Thompson, L., Hamstra, M., Shah, S. A., & Quesada, O. (2024). Enhanced External Counterpulsation for the Treatment of Angina With Nonobstructive Coronary Artery Disease. The American journal of cardiology, 211, 89–93. https://doi.org/10.1016/j.amjcard.2023.10.061 [Pubmed]
  2. Yang, H., Song, L., Ning, X., Ma, Y., Xue, A., Zhao, H., Du, Y., Lu, Q., Liu, Z., & Wang, J. (2022). Enhanced external counterpulsation ameliorates endothelial dysfunction and elevates exercise tolerance in patients with coronary artery disease. Frontiers in cardiovascular medicine, 9, 997109. https://doi.org/10.3389/fcvm.2022.997109 [Pubmed]
  3. Jan, R., Khan, A., Zahid, S., Sami, A., Owais, S. M., Khan, F., Asjad, S. J., Jan, M. H., & Awan, Z. A. (2020). The Effect of Enhanced External Counterpulsation (EECP) on Quality of life in Patient with Coronary Artery Disease not Amenable to PCI or CABG. Cureus, 12(5), e7987. https://doi.org/10.7759/cureus.7987 [Pubmed]
  4. Caceres, J., Atal, P., Arora, R., & Yee, D. (2021). Enhanced external counterpulsation: A unique treatment for the “No-Option” refractory angina patient. Journal of clinical pharmacy and therapeutics, 46(2), 295–303. https://doi.org/10.1111/jcpt.13330 [Pubmed]
  5. Abdelwahab, A. A., & Elsaied, A. M. (2018). Can enhanced external counter pulsation as a non-invasive modality be useful in patients with ischemic cardiomyopathy after coronary artery bypass grafting?. The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology, 70(2), 119–123. https://doi.org/10.1016/j.ehj.2018.01.002 [Pubmed]
  6. Manchanda, A., & Soran, O. (2007). Enhanced external counterpulsation and future directions: step beyond medical management for patients with angina and heart failure. Journal of the American College of Cardiology, 50(16), 1523–1531. https://doi.org/10.1016/j.jacc.2007.07.024 [Pubmed]
  7. Loh, P. H., Cleland, J. G., Louis, A. A., Kennard, E. D., Cook, J. F., Caplin, J. L., Barsness, G. W., Lawson, W. E., Soran, O. Z., & Michaels, A. D. (2008). Enhanced external counterpulsation in the treatment of chronic refractory angina: a long-term follow-up outcome from the International Enhanced External Counterpulsation Patient Registry. Clinical cardiology, 31(4), 159–164. https://doi.org/10.1002/clc.20117 [Pubmed]
  8.  Lawson, W. E., Hui, J. C., Barsness, G. W., Kennard, E. D., Kelsey, S. F., & IEPR Investigators (2004). Effectiveness of enhanced external counterpulsation in patients with left main disease and angina. Clinical cardiology, 27(8), 459–463. https://doi.org/10.1002/clc.4960270808 [Pubmed]
  9. Casey, D. P., Conti, C. R., Nichols, W. W., Choi, C. Y., Khuddus, M. A., & Braith, R. W. (2008). Effect of enhanced external counterpulsation on inflammatory cytokines and adhesion molecules in patients with angina pectoris and angiographic coronary artery disease. The American journal of cardiology, 101(3), 300–302. https://doi.org/10.1016/j.amjcard.2007.08.031 [Pubmed]
  10. Hashemi, M., Hoseinbalam, M., & Khazaei, M. (2008). Long-term effect of enhanced external counterpulsation on endothelial function in the patients with intractable angina. Heart, lung & circulation, 17(5), 383–387. https://doi.org/10.1016/j.hlc.2008.02.001 [Pubmed]
  11. Campbell, A. R., Satran, D., Zenovich, A. G., Campbell, K. M., Espel, J. C., Arndt, T. L., Poulose, A. K., Boisjolie, C. R., Juusola, K., Bart, B. A., & Henry, T. D. (2008). Enhanced external counterpulsation improves systolic blood pressure in patients with refractory angina. American heart journal, 156(6), 1217–1222. https://doi.org/10.1016/j.ahj.2008.07.024 [Pubmed]
  12. Lawson, W. E., Hui, J. C., & Lang, G. (2000). Treatment benefit in the enhanced external counterpulsation consortium. Cardiology, 94(1), 31–35. https://doi.org/10.1159/000007043 [Pubmed]
  13.  Zhao, S., Liu, S., Wen, Y., Qi, Q., & Huang, P. (2022). Analysis of the Effect of External Counterpulsation Combined With High-Intensity Aerobic Exercise on Cardiopulmonary Function and Adverse Cardiovascular Events in Patients With Coronary Heart Disease After PCI. Frontiers in surgery, 9, 851113. https://doi.org/10.3389/fsurg.2022.851113 [Pubmed]
  14. Esmaeilzadeh, M., Khaledifar, A., Maleki, M., Sadeghpour, A., Samiei, N., Moladoust, H., Noohi, F., Haghighi, Z. O., & Mohebbi, A. (2009). Evaluation of left ventricular systolic and diastolic regional function after enhanced external counter pulsation therapy using strain rate imaging. European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology, 10(1), 120–126. https://doi.org/10.1093/ejechocard/jen183 [Pubmed]
  15. Feldman, A. M., Silver, M. A., Francis, G. S., Abbottsmith, C. W., Fleishman, B. L., Soran, O., de Lame, P. A., Varricchione, T., & PEECH Investigators (2006). Enhanced external counterpulsation improves exercise tolerance in patients with chronic heart failure. Journal of the American College of Cardiology, 48(6), 1198–1205. https://doi.org/10.1016/j.jacc.2005.10.079 [Pubmed]

Erectile Dysfunction

  1. Lawson, W. E., Hui, J. C., Kennard, E. D., Soran, O., McCullough, P. A., Kelsey, S. F., & IEPR Investigators (2007). Effect of enhanced external counterpulsation on medically refractory angina patients with erectile dysfunction. International journal of clinical practice, 61(5), 757–762. https://doi.org/10.1111/j.1742-1241.2007.01328.x [Pubmed]
  2. El-Sakka, A. I., Morsy, A. M., & Fagih, B. I. (2007). Enhanced external counterpulsation in patients with coronary artery disease-associated erectile dysfunction. Part II: impact of disease duration and treatment courses. The journal of sexual medicine, 4(5), 1448–1453. https://doi.org/10.1111/j.1743-6109.2007.00550.x [Pubmed]
  3. Froschermaier, S. E., Werner, D., Leike, S., Schneider, M., Waltenberger, J., Daniel, W. G., & Wirth, M. P. (1998). Enhanced external counterpulsation as a new treatment modality for patients with erectile dysfunction. Urologia internationalis, 61(3), 168–171. https://doi.org/10.1159/000030315 [Pubmed]

Stroke

  1. Lin, W., Han, J., Chen, X., Xiong, L., Leung, H. W., Leung, T. W., Soo, Y., & Wong, L. K. (2013). Predictors of good functional outcome in counterpulsation-treated recent ischaemic stroke patients. BMJ open, 3(6), e002932. https://doi.org/10.1136/bmjopen-2013-002932 [Pubmed]
  2. Liu, L., Ding, J., Leng, X., Pu, Y., Huang, L. A., Xu, A., Wong, K. S. L., Wang, X., & Wang, Y. (2018). Guidelines for evaluation and management of cerebral collateral circulation in ischaemic stroke 2017. Stroke and vascular neurology, 3(3), 117–130. https://doi.org/10.1136/svn-2017-000135 [Pubmed]

Quality of Life

  1. Singh V, Kumari G, Chhajer B, Jhingan AK, Dahiya S. A Comparative Assessment to Evaluate Enhanced External Counter Pulsation Effect on Physical Profile and Quality of Life in Diabetic and Non-Diabetic Coronary Heart Disease Patients. J App Pharm Sci, 2018; 8(06): 113-123. http://dx.doi.org/10.7324/JAPS.2018.8615 [Link]
  2. Lin, S., Xiao-Ming, W., & Gui-Fu, W. (2020). Expert consensus on the clinical application of enhanced external counterpulsation in elderly people (2019). Aging medicine (Milton (N.S.W)), 3(1), 16–24. https://doi.org/10.1002/agm2.12097 [Pubmed]

Sports & Recovery

  1. Roberts, L. A., Caia, J., James, L. P., Scott, T. J., & Kelly, V. G. (2019). Effects of External Counterpulsation on Postexercise Recovery in Elite Rugby League Players. International journal of sports physiology and performance, 14(10), 1350–1356. https://doi.org/10.1123/ijspp.2018-0682 [Pubmed]
  2. Zhao, M., Huang, Y., Li, L., Zhou, L., Wu, Z., Liu, Y., Zhang, H., & Hu, C. (2020). Enhanced External Counterpulsation Efficacy on Exercise Endurance in COPD Patients and Healthy Subjects: A Pilot Randomized Clinical Trial. International journal of chronic obstructive pulmonary disease, 15, 25–31. https://doi.org/10.2147/COPD.S225566 [Pubmed]

Renal Disease

  1. Ruangkanchanasetr, P., Mahanonda, N., Raungratanaamporn, O., Ruckpanich, P., Kitiyakara, C., Chaiprasert, A., Adirekkiat, S., Punpanich, D., Vanavanan, S., Chittamma, A., & Supaporn, T. (2013). Effect of enhanced external counterpulsation treatment on renal function in cardiac patients. BMC nephrology, 14, 193. https://doi.org/10.1186/1471-2369-14-193 [Pubmed]

Diabetes

  1. Coombes, J. S., Dias, K. A., Lal, R., Fassett, R. G., Wallen, M. P., Ramos, J. S., Russell, S., Vear, N. K., Gajanand, T., Bailey, T. G., Green, D. J., Coombes, B. K., & Roberts, L. A. (2023). Efficacy of two doses of external counterpulsation (ECP) on glycemic control in people with type 2 diabetes mellitus: A randomized SHAM-controlled trial. Diabetes research and clinical practice, 200, 110701. https://doi.org/10.1016/j.diabres.2023.110701 [Pubmed]
  2. Martin, J. S., Beck, D. T., Aranda, J. M., Jr, & Braith, R. W. (2012). Enhanced external counterpulsation improves peripheral artery function and glucose tolerance in subjects with abnormal glucose tolerance. Journal of applied physiology (Bethesda, Md. : 1985), 112(5), 868–876. https://doi.org/10.1152/japplphysiol.01336.2011 [Pubmed]
  3. Nagendra, L., Dutta, D., Sharma, M., & Bg, H. (2023). Impact of Enhanced External Counter-pulsation Therapy on Glycaemic Control in People With Prediabetes and Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis. TouchREVIEWS in endocrinology, 19(2), 9–15. https://doi.org/10.17925/EE.2023.19.2.8 [Pubmed]
  4. Sardina, P. D., Martin, J. S., Avery, J. C., & Braith, R. W. (2016). Enhanced external counterpulsation (EECP) improves biomarkers of glycemic control in patients with non-insulin-dependent type II diabetes mellitus for up to 3 months following treatment. Acta diabetologica, 53(5), 745–752. https://doi.org/10.1007/s00592-016-0866-9 [Pubmed]
  5. Sardina, P. D., Martin, J. S., Dzieza, W. K., & Braith, R. W. (2016). Enhanced external counterpulsation (EECP) decreases advanced glycation end products and proinflammatory cytokines in patients with non-insulin-dependent type II diabetes mellitus for up to 6 months following treatment. Acta diabetologica, 53(5), 753–760. https://doi.org/10.1007/s00592-016-0869-6 [Pubmed]

Restless Legs Syndrome

  1. Rajaram, S. S., Shanahan, J., Ash, C., Walters, A. S., & Weisfogel, G. (2005). Enhanced external counter pulsation (EECP) as a novel treatment for restless legs syndrome (RLS): a preliminary test of the vascular neurologic hypothesis for RLS. Sleep medicine, 6(2), 101–106. https://doi.org/10.1016/j.sleep.2004.10.012 [Pubmed]

Venous Leg Symptoms

  1. Çuğlan, B., Turhan, H., & Yetkin, E. (2022). Enhanced External Counterpulsation Effects on Venous Leg Symptoms. Anatolian journal of cardiology, 26(5), 401–406. https://doi.org/10.5152/AnatolJCardiol.2022.1350 [Pubmed]

Numerous clinical studies and research trials have been conducted to evaluate the efficacy, safety, and potential mechanisms of action of EECP therapy. These studies have investigated its use in conditions such as:

  • Chronic stable angina
  • Coronary artery disease
  • Chronic stable Heart failure
  • Peripheral artery disease
  • Hypertension
  • Erectile dysfunction
  • Diabetic neuropathy
  • Cerebral ischemia
  • Neurological disorders

Research on EECP has provided evidence supporting its effectiveness in improving symptoms, quality of life, exercise tolerance, and cardiac function. Additionally, studies have explored the physiological mechanisms underlying EECP therapy, including its effects on vascular function, endothelial function, myocardial perfusion, and neurohormonal regulation.

The body of research on EECP continues to grow, with ongoing studies exploring its potential applications, optimising treatment protocols, and identifying patient populations who may benefit most from this therapy. Overall, the published research on EECP contributes to the evidence base supporting its use as a non-invasive treatment option for various cardiovascular and related conditions.

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