nhanced external counterpulsation (EECP) is a noninvasive method of assisting the circulation, which enhances diastolic augmentation and systolic unloading by means of a pressurized air cuff around the patient's legs that is maintained at approximately 300 mmHg during diastole. 1 In the United States, the effectiveness of this method in chronic angina has been reported, 2,3 and its effectiveness has been confirmed in a large-scale clinical trial. 4 It has been concluded that the increase in

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... nary blood flow by EECP treatment is mainly through diastolic augmentation, which is similar to the effect on the arterial system by intraaortic balloon pumping (IABP), but EECP also has an effect on venous return. It can be implemented immediately, and is noninvasive without risk of bleeding or infection, which is a great advantage compared with IABP. 5, 6 It is anticipated that EECP will help improve the circulation in patients with acute heart failure and acute coronary syndrome. We previously reported that in patients with acute myocardial infarction (AMI) EECP produced diastolic augmentation similar to IABP, but increased preload and the cardiac index (CI) with increased venous return, which is different to IABP. 7 In this study, we used EECP in patients with AMI and observed the changes in neurohumoral factors, as well as the hemodynamic effects, to investigate its mechanism and effects on left cardiac function. Methods Study Population The subjects were 24 patients (20 male, 4 female; mean age: 61±8 years) with AMI who were treated successfully with reperfusion therapy (percutaneous transluminal coronary angioplasty) within 12 h of onset (Table 1 ). All patients were in a stable condition 48-72 h after the onset and were expected to be discharged from the coronary care unit. The exclusion criteria were heart failure of Killip Class III or higher, serum creatinine concentration of 2.0 mg/dl or higher, and arteriosclerosis obliterans. In addition, 4 pa-