Long-term effects of enhanced external counterpulsation in the management of patients with ischemic chronic heart failure

Aim. To study the long-term effects of complex therapy with the addition of enhanced external counterpulsation (EECP) in patients with stable coronary artery disease (CAD) complicated by chronic heart failure (CHF).Material and methods. In the open randomized trial EXCEL (NCT05913778), 118 Patients with the verified ischemic CHF NYHA class II-III with reduced or intermediate left ventricular ejection fraction were included. They were randomized into group 1 (n=59) — optimal medical therapy (OMT) and EECP (35 hours, 2 courses per year), group 2 (n=59) — OMT and EECP (35 hours, 1 course per year). The primary endpoint was the proportion of patients with a 6-minute walk test (6MWT) increase of at least 20% from baseline. The secondary composite endpoint included adverse cardiovascular clinical outcomes (myocardial infarction, revascularization, stroke, death), new cases of atrial fibrillation, diabetes mellitus, decreased renal function, and hospitalizations for CHF.Results. The average CHF NYHA class decreased in group 1 from 2.41±0.49 initially to 1.95±0.47 after 24 months (p20% (primary endpoint) in groups 1 and 2 after 24 months was 98.3% (n=58) and 79.7% (n= 46) respectively (p20%) — 16.4 times lower (odds ratio 0.061, 95% confidence interval 0.008-0.484; p=0.009).Conclusion. Over the 24-month study period, the effect of EECP in patients with coronary artery disease complicated by CHF demonstrated a stable improvement in exercise tolerance, as well as a decrease in the incidence of adverse clinical outcomes, significantly more pronounced in the group with a large number of EECP procedures