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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/05/26 19:24:17」(JST)

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Illustration depicting Cardiac External Counterpulsation

External counterpulsation therapy (ECP) is a procedure performed on individuals with angina or heart failure or cardiomyopathy in order to diminish symptoms of ischemia, improve functional capacity and quality of life. In various studies, ECP has been shown to relieve angina,^[1]^[2] and decrease the degree of ischemia in a cardiac stress test.^[2]^[3]

Method

While an individual is undergoing ECP, he/she has pneumatic cuffs on his or her legs and is connected to telemetry monitors that monitor heart rate and rhythm. The most common type in use involves three cuffs placed on each leg (on the calves, the lower thighs, and the upper thighs (or buttock)). The cuffs are timed to inflate and deflate based on the individual's electrocardiogram. The cuffs should ideally inflate at the beginning of diastole and deflate at the beginning of systole. During the inflation portion of the cycle, the calf cuffs inflate first, then the lower thigh cuffs and finally the upper thigh cuffs. Inflation is controlled by a pressure monitor, and the cuffs are inflated to about 200 mmHg.

When timed correctly, this will decrease the afterload that the heart has to pump against, and increase the preload that fills the heart, increasing the cardiac output.^[4] In this way, ECP is similar to the intra-aortic balloon pump (IABP). Since it increases pressure in the aorta while the heart is relaxing (during diastole) ECP also increases blood flow into the coronary arteries, which also occurs during that phase.

Physiological considerations

One theory is that ECP exposes the coronary circulation to increased shear stress, and that this results in the production of a cascade of growth factors that result in angiogenesis.^[5] ECP is a rehabilitation process that provides mechanical external cardiac assistance on a consistent regimen resulting in significant improvement in energy and exercise tolerance much like an exercise program. By restoring oxygenated blood flow, there are abundant benefits to the body. This restoration of nutrient rich blood flow revives tissue in parts of the heart and body that have become 'stunned' or 'hibernated' due to restricted or blocked blood flow.^{[citation needed]} The heart benefits greatly as patients will see an improvement in structure, strength (contracility) and a reduction in afterload (workload) due to the reduction in systemic vascular resistance.^{[citation needed]} Patients will see improvements in symptoms of chest pain, shortness of breath, chronic fatigue (tiredness) as well as a significant improvement in exercise tolerance (energy).^{[citation needed]}

Indications and Contraindications

Indications

Angina patients who are not relieved by medicine
Patients who don’t want to have bypass surgery
Patients who are contraindicated for bypass or angioplasty due to kidney failure, liver failure, severe COPD cases, diffuse diabetes disease, very old age, patients of Syndrome X, ischaemic and dilated cardiomyopathy

Contraindications

Severe aortic regurgitation or aortic stenosis
Deep vein thrombosis
Pregnancy
Very high blood pressure
Severe peripheral vascular disease
Possibility of stroke

References

^ Zheng ZS, Li TM, Kambic H; et al. (1983). "Sequential external counterpulsation (SECP) in China". Trans Am Soc Artif Intern Organs 29: 599–603. PMID 6673295.
^ ^a ^b Arora RR, Chou TM, Jain D; et al. (June 1999). "The multicenter study of enhanced external counterpulsation (MUST-EECP): effect of ECP on exercise-induced myocardial ischemia and anginal episodes". J. Am. Coll. Cardiol. 33 (7): 1833–40. doi:10.1016/S0735-1097(99)00140-0. PMID 10362181.
^ Lawson WE, Hui JC, Zheng ZS; et al. (1996). "Improved exercise tolerance following enhanced external counterpulsation: cardiac or peripheral effect?". Cardiology 87 (4): 271–5. doi:10.1159/000177103. PMID 8793157.
^ Werner D, Schneider M, Weise M, Nonnast-Daniel B, Daniel WG (October 1999). "Pneumatic external counterpulsation: a new noninvasive method to improve organ perfusion". Am. J. Cardiol. 84 (8): 950–2, A7–8. doi:10.1016/S0002-9149(99)00477-4. PMID 10532522.
^ Soran O, Crawford LE, Schneider VM, Feldman AM (March 1999). "Enhanced external counterpulsation in the management of patients with cardiovascular disease". Clin Cardiol 22 (3): 173–8. doi:10.1002/clc.4960220304. PMID 10084058.
Manchanda A, Soran O (October 2007). "Enhanced external counterpulsation and future directions: step beyond medical management for patients with angina and heart failure". J. Am. Coll. Cardiol. 50 (16): 1523–31. doi:10.1016/j.jacc.2007.07.024. PMID 17936150.

UpToDate Contents

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1. 大動脈内バルーンポンプカウンターパルセーション intraaortic balloon pump counterpulsation
2. 心不全に対して効果が期待できる新しい治療 possibly effective emerging therapies for heart failure
3. 狭心症の新しい治療法 new therapies for angina pectoris
4. 急性冠症候群における急性非代償性心不全の治療 treatment of acute decompensated heart failure in acute coronary syndromes
5. ストレス誘発性（たこつぼ型）心筋症 stress induced takotsubo cardiomyopathy

English Journal

Importance of Total Ischemic Time and Preprocedural Infarct-Related Artery Blood Flow in Predicting Infarct Size in Patients With Anterior Wall Myocardial Infarction (from the CRISP-AMI Trial).

Vemulapalli S, Zhou Y, Gutberlet M, Kumar AS, Mills JS, Blaxill J, Smalling R, Ohman EM, Patel MR.SourceDivision of Cardiology, Duke University Medical Center, Durham, North Carolina. Electronic address: sreekanth.vemulapalli@duke.edu.
The American journal of cardiology.Am J Cardiol.2013 Jun 14. pii: S0002-9149(13)01219-8. doi: 10.1016/j.amjcard.2013.05.021. [Epub ahead of print]
The goal of this study was to characterize determinants of infarct size in the multicenter randomized Counterpulsation to Reduce Infarct Size Pre-PCI Acute Myocardial Infarction (CRISP-AMI) trial. Contemporary determinants of infarct size in patients presenting with acute anterior myocardial infarct
PMID 23768458

The human coronary collateral circulation: development and clinical importance.

Seiler C, Stoller M, Pitt B, Meier P.SourceDepartment of Cardiology, University Hospital, Bern CH-3010, Switzerland.
European heart journal.Eur Heart J.2013 Jun 5. [Epub ahead of print]
Coronary collaterals are an alternative source of blood supply to myocardium jeopardized by ischaemia. In comparison with other species, the human coronary collateral circulation is very well developed. Among individuals without coronary artery disease (CAD), there are preformed collateral arteries
PMID 23739241
PMID 22560950

Japanese Journal

Devices in Heart Failure:– The New Revolution –

Gafoor Sameer,Franke Jennifer,Lam Simon,Reinartz Markus,Bertog Stefan,Vaskelyte Laura,Hofmann Ilona,Sievert Horst
Circulation Journal 79(2), 237-244, 2015
… This review goes through the devices used in heart failure, including left ventricular reconstruction, aortic counterpulsation, short-term mechanical circulatory support, long-term mechanical circulatory support, and right heart interventions. …
NAID 130004927079

Devices in Heart Failure:– The New Revolution –

Gafoor Sameer,Franke Jennifer,Lam Simon,Reinartz Markus,Bertog Stefan,Vaskelyte Laura,Hofmann Ilona,Sievert Horst
Circulation Journal advpub(0), 2015
… This review goes through the devices used in heart failure, including left ventricular reconstruction, aortic counterpulsation, short-term mechanical circulatory support, long-term mechanical circulatory support, and right heart interventions. …
NAID 130004725116