Long-COVID Symptoms and Novel Enhanced External Counterpulsation Therapy

Shot of a young female doctor using a digital tablet during a consultation with a mature man suffering from long covid long
A retrospective study was conducted to determine if enhanced external counterpulsation is an effective therapy for long-COVID.

Validated markers assessing long-COVID symptoms were improved in a clinically meaningful manner with enhanced external counterpulsation (EECP) according to findings presented at The American College of Cardiology Cardiovascular Summit Virtual (CV Summit) held virtually on February 17-19, 2022.

Approximately 6 months after SARS-CoV-2 infection acute phase, 50% of patients worldwide have lingering symptoms. EECP is known to improve cerebral and cardiac perfusion, and is a noninvasive technique that researchers sought to evaluate as a novel therapy for long-COVID symptoms in patients with and without coronary artery disease.

To investigate this, researchers performed a retrospective study of electronic health records of 33 patients (median age 53±15 years) with long-COVID symptoms (postacute sequelae of SARS-CoV-2 infection) with or without coronary artery disease (CAD) who were referred to Flow Therapy centers for EECP treatment (minimum 15 hours of EECP therapy, 1 hour/day). Researchers assessed Seattle Angina Questionnaire-7 (SAQ7) summary score, Duke Activity Status Index (DASI), PROMIS Fatigue Instrument (PROMIS), Rose Dyspnea Scale (RDS), and 6-minute walk test (6MWT) before and after EECP. A paired student’s t test was performed.

SAQ7 and DASI showed significant improvement, from 54.9±23.8 to 78.9±21.8 (P <.001) and 11.6±14.0 to 31.8±16.5 P <.001), respectively. PROMIS fatigue score improved (15.8±3.9 to 10.3±4.2 [P <.001]). RDS showed significant decrease (2.7±1.3 to 1.4±1.4; [P <.001]), and the 6MWT improved (1,268±376 to 1,447±402 [P <.001]).

For patients with long-COVID only, change from baseline was significant for all endpoints (all P-values <.015). Between patients with long-COVID only and patients with long-COVID with CAD, no difference was noted (all P-values >.135).

The researchers wrote, “EECP improved validated markers assessing long-COVID symptoms in a clinically meaningful manner,” and suggested that studies with a larger sample size with a sham-control group were warranted to validate their findings.


Sathyamoorthy M, Cabrera J, Gutierrez M, Ward R, Shah SA. Enhanced external counterpulsation improves outcomes in patients with long-COVID. Presented at: The American College of Cardiology’s Cardiovascular Summit virtual conference (CV Summit); February 17-19, 2022.

This article originally appeared on The Cardiology Advisor