Mengenal Terapi External Counterpulsation (ECP)
Penyakit jantung adalah salah satu masalah kesehatan terbesar di Indonesia, termasuk didalamnya adalah penyakit jantung koroner. Berbagai macam cara dikembangkan untuk kemudian menangani penyakit jantung ini, dan terbukti perkembangan tatalaksana yang intensif dan tatalaksana intervensi pun sangat berkembang dalam penanganan penyakit jantung koroner ini. Namun, tentu saja tidak semua pasien dapat dilakukan tatalaksana yang intensif dan bersifat intervensi seperti pemasangan stent atau operasi bedah pintas koroner (BPAK), dan pasien-pasien ini dapat saja mengalami keluhan nyeri dada atau angina refrakter yang diakibatkan penyakit jantung koronernya tersebut. Pada pasien-pasien yang tidak dapat dilakukan tatalaksana yang bersifat intervensi, maka dapat dilakukan tatalaksana lain yang less invansive, misalnya laser revascularization, left stellate ganglion blockade, spinal cord stimulation (SCS) dan external counterpulsation (ECP).<!--[if supportFields]>ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"abstract":"Penyakit kardiovaskular mempunyai prevalensi yang tinggi dan dengan angka morbiditas yang tinggi serta dapat menurunkan produkti?tas penderitanya, menurunkan kualitas hidup dan sering mengalami perawatan ulangan. padahal penyakit kardiovaskular pada umumnya merupakan penyakit yang sangat ideal untuk dilakukan upaya promotif, preventif dan rehabilitatif, karena prosesnya penyakitnya jangka panjang, tetapi kejadian kegawatan bisa muncul mendadak, dapat menyebabkan kematian dan morbiditas yang tinggi, dan memerlukan biaya pengobatan yang tinggi. Namum sebagian besar upaya pencegahan dapat dilakukan melalui upaya perubahan pola hidup","id":"ITEM-1","issued":{"date-parts":[["2019"]]},"title":"Edisi pertama, 2019","type":"article-journal"},"uris":["https://www.mendeley.com/documents/?uuid=a330443f-869f-44af-b891-0925ac1a352d"]}],"mendeley":{"formattedCitation":"1","plainTextFormattedCitation":"1","previouslyFormattedCitation":"1"},"properties":{"noteIndex":0},"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"}<![endif]-->1<!--[if supportFields]><![endif]-->
Terapi External Counterpulsation (ECP) adalah teknik non invansif dengan tujuan mengurangi gejala nyeri dada akibat penyakit jantung koroner dengan mekanisme utamanya adalah dengan memakai manset yang dipasang pada area betis, paha, dan bokong, dimana manset ini akan mengembang dan mengempis sesuai perekaman jantung memakai alat EKG. Proses mengembang dan mengempis akan memberikan pasokan darah kembali ke arteri koroner sehingga dengan begitu arteri koroner akan mendapat asupan nutrisi dan oksigen, serta darah yang berada di vena akan cepat menuju jantung dikarenakan peningkatan tekanan. Sudah banyak teori yang mendukung keuntungan klinis dari ECP ini baik secara jangka pendek maupun jangka panjang, dimana pada efek jangka Panjang diperkirakan muncul perkembangan pembuluh darah baru (kolateral) yang akan menutrisi otot-otot jantung sehingga mengurangi angina/nyeri dada akibat penyakit jantung koroner.<!--[if supportFields]>ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"abstract":"Penyakit kardiovaskular mempunyai prevalensi yang tinggi dan dengan angka morbiditas yang tinggi serta dapat menurunkan produkti?tas penderitanya, menurunkan kualitas hidup dan sering mengalami perawatan ulangan. padahal penyakit kardiovaskular pada umumnya merupakan penyakit yang sangat ideal untuk dilakukan upaya promotif, preventif dan rehabilitatif, karena prosesnya penyakitnya jangka panjang, tetapi kejadian kegawatan bisa muncul mendadak, dapat menyebabkan kematian dan morbiditas yang tinggi, dan memerlukan biaya pengobatan yang tinggi. Namum sebagian besar upaya pencegahan dapat dilakukan melalui upaya perubahan pola hidup","id":"ITEM-1","issued":{"date-parts":[["2019"]]},"title":"Edisi pertama, 2019","type":"article-journal"},"uris":["https://www.mendeley.com/documents/?uuid=a330443f-869f-44af-b891-0925ac1a352d"]}],"mendeley":{"formattedCitation":"1","manualFormatting":"1,2","plainTextFormattedCitation":"1","previouslyFormattedCitation":"1"},"properties":{"noteIndex":0},"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"}<![endif]-->1,<!--[if supportFields]>ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.3121/cmr.2013.1169","ISSN":"15394182","PMID":"24510321","abstract":"Enhanced external counterpulsation (EECP) has been approved by the United States Food and Drug Administration (FDA) for management of refractory angina (Class IIb). EECP uses three sets of pneumatic cuffs that sequentially contract during diastole, increasing aortic diastolic pressure, augmenting coronary blood flow and central venous return. EECP improves anginal symptoms and exercise tolerance, and reduces nitroglycerin use in patients with chronic, stable angina. EECP has also been shown to be safe and beneficial in patients with symptomatic stable congestive heart failure. It has been postulated that cardiac benefits of EECP are mediated though vascular endothelial growth factor (VEGF) and nitric oxide mediated vasodilatation and angiogenesis. In June 2002, the FDA also approved EECP therapy for heart failure patients. © 2013 Marshfield Clinic.","author":[{"dropping-particle":"","family":"Sharma","given":"Umesh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ramsey","given":"Heidi K.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tak","given":"Tahir","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Clinical Medicine and Research","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2013"]]},"page":"226-232","title":"The role of enhanced external counter pulsation therapy in clinical practice","type":"article-journal","volume":"11"},"uris":["https://www.mendeley.com/documents/?uuid=ac39875f-c36c-40e5-bcd4-e012f2820021"]}],"mendeley":{"formattedCitation":"2","plainTextFormattedCitation":"2","previouslyFormattedCitation":"2"},"properties":{"noteIndex":0},"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"}<![endif]-->2<!--[if supportFields]><![endif]--><!--[if supportFields]><![endif]-->
Beberapa penelitian juga menunjukkan hasil yang baik pada ECP ini, salah satunya adalah penelitian Multicenter Study of Enhanced External Counterpulsation (MUST-EECP) yang dilakukan pada 139 pasien dengan angina stabil kronis kemudian dilakukan penelitian dengan diberikan terapi ECP dibandingkan yang tidak diberikan ECP, hasilnya adalah perbaikan koroner yang ditunjukkan melalui EKG, dan peningkatan kapasitas latihan serta kualitas hidup/quality of life (QOL).<!--[if supportFields]>ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/S0735-1097(99)00140-0","ISSN":"07351097","PMID":"10362181","abstract":"OBJECTIVES: The purpose of this study was to assess safety and efficacy of enhanced external counterpulsation (EECP). BACKGROUND: Case series have shown that EECP can improve exercise tolerance, symptoms and myocardial perfusion in stable angina pectoris. METHODS:: A multicenter, prospective, randomized, blinded, controlled trial was conducted in seven university hospitals in 139 outpatients with angina, documented coronary artery disease (CAD) and positive exercise treadmill test. Patients were given 35 h of active counterpulsation (active CP) or inactive counterpulsation (inactive CP) over a four- to seven-week period. Outcome measures were exercise duration and time to ?1-mm ST-segment depression, average daily anginal attack count and nitroglycerin usage. RESULTS:: Exercise duration increased in both groups, but the between-group difference was not significant (p > 0.3). Time to ?1-mm ST-segment depression increased significantly from baseline in active CP compared with inactive CP (p = 0.01). More active-CP patients saw a decrease and fewer experienced an increase in angina episodes as compared with inactive-CP patients (p < 0> 0.7). CONCLUSIONS:: Enhanced external counterpulsation reduces angina and extends time to exercise-induced ischemia in patients with symptomatic CAD. Treatment was relatively well tolerated and free of limiting side effects in most patients.","author":[{"dropping-particle":"","family":"Arora","given":"Rohit R.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chou","given":"Tony M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Jain","given":"Diwakar","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fleishman","given":"Bruce","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Crawford","given":"Lawrence","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"McKiernan","given":"Thomas","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nesto","given":"Richard W.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of the American College of Cardiology","id":"ITEM-1","issue":"7","issued":{"date-parts":[["1999"]]},"page":"1833-1840","publisher":"Elsevier Masson SAS","title":"The multicenter study of enhanced external counterpulsation (MUST-EECP): Effect of EECP on exercise-induced myocardial ischemia and anginal episodes","type":"article-journal","volume":"33"},"uris":["https://www.mendeley.com/documents/?uuid=b8a2d5e9-f2ba-4678-b759-e49f38638f37"]}],"mendeley":{"formattedCitation":"3","plainTextFormattedCitation":"3","previouslyFormattedCitation":"3"},"properties":{"noteIndex":0},"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"}<![endif]-->3<!--[if supportFields]><![endif]--> Sebuah meta-analisis yang lebih baru dilakukan pada tahun 2020 di China, menggabungkan berbagai penelitian terkait efektivitas dari ECP, dan hasil akhirnya adalah ECP terbukti meningkatkan aliran darah ke arteri koroner sehingga akan memeprbaiki gejala angina/nyeri dada pada pasien yang sebelumnya sudah mengalami penyakit jantung koroner.<!--[if supportFields]>ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1371/journal.pone.0151822","ISSN":"19326203","PMID":"27045935","abstract":"Background: Enhanced external counterpulsation (EECP) is currently applied for treating coronary artery disease (CAD) patients. However, the mechanism(s) by which EECP ameliorates angina pectoris and long-term left ventricular function remain largely unknown. The aim of this study will be to assess whether EECP significantly affects myocardial perfusion in CAD patients through a systematic review and meta-analysis of the available literature. Methods: MEDLINE, EMBASE, and Cochrane CENTRAL databases were searched for prospective studies on CAD patients that underwent EECP and reported myocardial perfusion data preand post-EECP. The impact of EECP was assessed based on the weighted mean difference (WMD) in myocardial perfusion from pre-EECP to post-EECP. Statistical heterogeneity was assessed by the I2 index. Publication bias was assessed through visual inspection of the funnel plot as well as Begg's and Egger's testing. Results: Standard EECP therapy (i.e., 35-36 one-hour sessions within a seven-week period) significantly increased myocardial perfusion in CAD patients (pooled WMD: -0.19, 95% CI: -0.38 to 0.00, p = 0.049). A random effects analysis was applied on account of significant heterogeneity (I2 = 89.1%, p = 0.000). There was no evidence of significant publication bias (Begg's p = 0.091; Egger's p = 0.282). Conclusions: Standard EECP therapy significantly increases myocardial perfusion in CAD patients. This study's findings support the continued use of standard EECP therapy in CAD patients and provides one putative physiological mechanism to help explain the improvements in angina pectoris and long-term left ventricular function observed in CAD patients after EECP therapy.","author":[{"dropping-particle":"","family":"Qin","given":"Xiaoxia","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Deng","given":"Yanye","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wu","given":"Dandong","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yu","given":"Lehua","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Huang","given":"Rongzhong","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"PLoS ONE","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2016"]]},"page":"1-11","title":"Does enhanced external counterpulsation (EECP) significantly affect myocardial perfusion?: A systematic review & meta-analysis","type":"article-journal","volume":"11"},"uris":["https://www.mendeley.com/documents/?uuid=3400c76a-c4f5-4dd3-8e7b-ef5530894402"]}],"mendeley":{"formattedCitation":"4","plainTextFormattedCitation":"4","previouslyFormattedCitation":"4"},"properties":{"noteIndex":0},"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"}<![endif]-->4<!--[if supportFields]><![endif]--> ECP sendiri sudah mendapatkan rekomendasi dari European Society of Cardiology (ESC) yaitu rekomendasi kelas II A dengan level of Evidence B sebagai pengobatan angina pektoris yang berulang.<!--[if supportFields]>ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"abstract":"Penyakit kardiovaskular mempunyai prevalensi yang tinggi dan dengan angka morbiditas yang tinggi serta dapat menurunkan produkti?tas penderitanya, menurunkan kualitas hidup dan sering mengalami perawatan ulangan. padahal penyakit kardiovaskular pada umumnya merupakan penyakit yang sangat ideal untuk dilakukan upaya promotif, preventif dan rehabilitatif, karena prosesnya penyakitnya jangka panjang, tetapi kejadian kegawatan bisa muncul mendadak, dapat menyebabkan kematian dan morbiditas yang tinggi, dan memerlukan biaya pengobatan yang tinggi. Namum sebagian besar upaya pencegahan dapat dilakukan melalui upaya perubahan pola hidup","id":"ITEM-1","issued":{"date-parts":[["2019"]]},"title":"Edisi pertama, 2019","type":"article-journal"},"uris":["https://www.mendeley.com/documents/?uuid=a330443f-869f-44af-b891-0925ac1a352d"]}],"mendeley":{"formattedCitation":"1","plainTextFormattedCitation":"1","previouslyFormattedCitation":"1"},"properties":{"noteIndex":0},"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"}<![endif]-->1<!--[if supportFields]><![endif]-->
Berbagai alternatif pengobatan dan tatalaksana penyakit jantung koroner tentunya akan terus berkembang untuk memberikan pilihan dan opsi yang terbaik bagi pasien, pun begitu alangkah baiknya untuk tetap berusaha menjaga diri untuk terhindar dari penyakit jantung koroner, dengan tetap mengatur pola makan, stop merokok dan memperbanyak aktivitas fisik.
Daftar Pustaka
Panduan Pelayanan External Counterpulsation untuk Pasien dengan Penyakit Kardiovaskular.PERKI.Edisi pertama, 2019. 2019;
Sharma U, Ramsey HK, Tak T. The role of enhanced external counter pulsation therapy in clinical practice. Clin Med Res. 2013;11(4):226–32.
Arora RR, Chou TM, Jain D, Fleishman B, Crawford L, McKiernan T, et al. The multicenter study of enhanced external counterpulsation (MUST-EECP): Effect of EECP on exercise-induced myocardial ischemia and anginal episodes. J Am Coll Cardiol [Internet]. 1999;33(7):1833–40. Available from: https://dx.doi.org/10.1016/S0735-1097(99)00140-0
Qin X, Deng Y, Wu D, Yu L, Huang R. Does enhanced external counterpulsation (EECP) significantly affect myocardial perfusion?: A systematic review & meta-analysis. PLoS One. 2016;11(4):1–11.
Sumber gambar: dokumentasi RSJPD Harapan Kita
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