Cardiovascular Effects of Long-Term Treatment with Enhanced External Counterpulsation in Patients with Ischemic Heart Failure: Randomized, Placebo-Controlled, Open-Label Clinical Trial

(1) Background. Although treatment with enhanced external counterpulsation (EECP) in patients with ischemic chronic heart failure (CHF) is pathophysiologically justified, its long-term vascular effects remain insufficiently defined. We aimed to study the vascular effects of long-term complex treatment (36 months) including EECP in patients with ischemic CHF, and to examine the relationship between these effects and clinical outcomes. (2) Methods. A total amount of 120 patients with ischemic CHF were randomized to receive one course of EECP per year (35 h; Group 1), two courses of EECP per year (70 h; Group 2), or one course of placebo-counterpulsation per year (35 h; Group 0;). For a period of 36 months, all patients underwent annual assessments including transthoracic echocardiography, nailfold videocapillaroscopy, finger photoplethysmography, applanation tonometry, exercise tolerance testing, and clinical outcome monitoring. (3) Results. Compared to the placebo group, long-term EECP treatment in patients with ischemic CHF, was accompanied by a significantly greater increase in exercise tolerance (∆23.5-45.0% vs. 7.0%; <i>p</i> < 0.001) and improvements in left ventricular ejection fraction (∆9.9-19.6% vs. 5.6%; <i>p</i> < 0.001) and myocardial stress (decrease in NT-proBNP level ∆-80.4--82.4% vs. -75.8%; <i>p</i> < 0.001), as well as both functional and structural vascular parameters (<i>p</i> < 0.001). The effect size depended on the annual number of EECP courses. The highest event-free survival was found in Group 2. At 36 months, improvement of vascular parameters emerged as stronger predictors of reduced cardiovascular event risk compared to the 12-month. (4) Conclusions. Long-term EECP treatment of patients with ischemic CHF improves both functional and structural vascular parameters, with an increasing role of their improvement in reducing the risk of cardiovascular events after 36 months.