Efficacy of enhanced external counter pulsation in improving six minutes’ walk test in heart failure patients


  • Ramasamy Subramanian
  • Ahmed Shiek
  • Chokkalingam Meyyappan




Enhanced external counterpulsation, heart failure, six minutes’ walk test, diastolic augmentation, C-reactive protein


Introduction and Aim: Enhanced External Counterpulsation (EECP) is an outpatient treatment to improve myocardial perfusion in chronic stable angina patients. We studied the clinical response of heart failure patients' improvement in the functional class and exercise tolerance with EECP.


Materials and Methods: We prospectively evaluated twenty-six patients, who had completed a course of EECP with pre and post six minutes’ walk test, functional ability assessed by the New York heart association (NYHA) classification, renal parameters, lipid profile, and diastole to systole(d/s) ratio in terms of Peak amplitude (P) and Area (A) under the curve value.


Results: The study group's mean age is of 56 years. The mean left ventricular ejection fraction (LVEF) is 31.44± 5.5%. Patients' demography includes 81% were male, 30% with hypertension (HT),50% with diabetes mellitus (DM), 30%chronic smokers, 61% of them had triple vessel disease (TVD). All the patients improved by a minimum of one NYHA class improvement, Serum urea reduced from 34.37 ± 20.28 to 27.24 ± 18.73 mg/dL (P = 0.002), C-Reactive protein (CRP) reduced from 4.6± 8.0 to 3.76 ± 5.1 mg/dL (P = 0.62). In the measured lipid panel test, only low-density lipoprotein (LDL) reduction from 94.41 ± 38.66 to 80.51 ± 35.09 mg/dL was statistically significant (P =0.03). The six-minute walk test, post-EECP, improved significantly from 340.14 ± 68.5 to 385.5 ± 73.9 meters (P =0.0004). The LVEF increased from 31.44 ± 5.5 to 38.38 ± 8.69 % (P=0.001).


Conclusion: EECP treatment significantly improves shortness of breath, six minutes walking distance, and ejection fraction in heart failure patients. The treatment significantly reduces serum urea and LDL level. These positive changes may be due to a sudden increase in cardiac output and hyperdynamic circulation during the treatment. 

Author Biographies

Ramasamy Subramanian

Department of Cardiology, Chettinad Academy of Research, and education Kelambakkam, Kanchipuram 603103, Tamil Nadu, India

Ahmed Shiek

Department of Biostatistics, Chettinad Academy of Research, and education Kelambakkam, Kanchipuram 603103, Tamil Nadu, India

Chokkalingam Meyyappan

Department of Cardiology, Chettinad Academy of Research, and education Kelambakkam, Kanchipuram 603103, Tamil Nadu, India


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How to Cite

Subramanian R, Shiek A, Meyyappan C. Efficacy of enhanced external counter pulsation in improving six minutes’ walk test in heart failure patients. Biomedicine [Internet]. 2022 May 1 [cited 2022 Nov. 27];42(2):274-9. Available from: https://biomedicineonline.org/home/article/view/1224



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