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Objectives: To investigates the outcomes of enhanced external counterpulsation (EECP) among coronary microvascular disease (CMD) patients., Methods: Coronary microvascular disease patients were separated into the EECP (n=41) and control cohorts (n=42). Prior to and following the 4-week EECP program, coronary flow reserve (CFR) was recorded using transthoracic Doppler echocardiography. The serum endothelial nitric oxide synthase (eNOS) and endothelin-1 (ET-1) contents were analyzed by ELISA. Quality of life (QoL) was assessed by the Seattle Angina Questionnaire (SAQ) and the Canadian Cardiovascular Society (CCS) angina class., Results: After four weeks, CFR was substantially enhanced in the EECP versus control cohort ( p <0.05). Endothelin-1 was strongly diminished whereas eNOS was considerably upregulated in the EECP cohort. EECP also enhanced patients' SAQ scores and decreased the CCS angina class., Conclusion: Enhanced external counterpulsation may improve CFR and enhance the CMD patient QoL., (Copyright: © Saudi Medical Journal.)