Combined Enhanced External Counterpulsation and Hyperbaric Oxygen Therapy in Ischemic Cardiomyopathy: Interim Results of a Prospective Study

INTRODUCTION: Ischemic cardiomyopathy remains a major contributor to chronic heart failure despite optimal guideline-directed medical therapy (GDMT). HEAT HF (HBOT and EECP as Adjuvant Therapy in Heart Failure) is the first prospective study to investigate the effect of Enhanced External Counterpulsation (EECP) with adjunctive Hyperbaric Oxygen Therapy (HBOT) on enhancing cardiac function and improving clinical outcomes in patients with ischemic cardiomyopathy. METHODS: This prospective interventional study was conducted on 100 adult patients with ischemic cardiomyopathy [left ventricular ejection fraction (LVEF) ≤50%] who had undergone EECP therapy with HBOT. Data on LVEF, global longitudinal strain (GLS), NYHA class, 6-minute walk test (6MWT), NT-proBNP, serum creatinine, and heart failure-related hospitalizations were collected pre- and post-intervention. This study is an ongoing clinical trial registered with the Clinical Trials Registry - India (CTRI/2024/11/076912), registered on November 18, 2024. This analysis represents interim results at 6-month follow-up. RESULTS: There were 88% males, with a mean age of 61.5 ± 10.7 years. LVEF significantly improved from 34.17 ± 7.0 to 41.43 ± 7.0% (p<0.001). 6MWT distance increased from 243.7 ± 94.4 to 367.4 ± 72.5 m (p<0.001), and NYHA class improved from III/IV to mainly I (p<0.001). GLS, NT-proBNP, and heart failure admissions also showed significant improvements (p < 0.001). LDL levels slightly decreased (p=0.046), while serum urea and creatinine remained unchanged. Patients on more GDMT agents showed better EF improvements, suggesting a synergistic effect. CONCLUSION: EECP, combined with HBOT and optimal GDMT, significantly improves cardiac function, exercise capacity, symptom burden, and biochemical markers in ischemic cardiomyopathy. This non-invasive approach may offer a promising adjunct to standard heart failure management.