Abstract Body (Do not enter title and authors here):
Introduction
Enhanced External Counterpulsation (EECP) is a noninvasive outpatient therapy designed to improve arterial health, cardiac efficiency, and coronary collateral formation by applying sequential external pressure aligned with the patient’s cardiac cycle. It is primarily indicated for refractory angina that is not amenable to PCI or CABG with the opinion of a cardiologist. EECP can improve exercise tolerance, reduce anginal symptoms, and enhance endothelial function, offering a potential alternative for patients with ischemic HFrEF awaiting heart transplantation.

Description of a Case
A 58-year-old Hispanic female with a history of severe CAD, type II DM, hyperlipidemia, and CVA. A transthoracic echocardiogram (TTE) revealed a dilated LV with an EF of 20%, left atrial enlargement, severe mitral regurgitation, moderate tricuspid regurgitation, right ventricular systolic pressure of 42 mm HG, trivial pericardial effusion, akinesis of the inferior wall, and hypokinesis of the anterior wall. Despite being a heart transplantation candidate, she declined revascularization and sought alternative treatments for angina, dyspnea, and daily activity limitations. The patient underwent EECP, consisting of 35 one-hour sessions over seven weeks. Following EECP, the patient demonstrated improvements in her Canadian Cardiovascular Society angina score (IV to I), New York Association class (IV to I), six-minute walk test performance, and EF (increased to 55%, observed from TTE). Due to these improvements, she was delisted for heart transplantation.

Discussion
This case illustrates the potential of EECP as an effective noninvasive treatment for patients with symptomatic ischemic HFrEF who are awaiting heart transplantation but are ineligible or unwilling to undergo surgical interventions. Not only did EECP improve the patient's angina and functional status, but it also enhanced her cardiac function. Based on the findings of this case report, further studies should be done to expand the indications of EECP to include HF and other similar patient populations. EECP may alleviate the need for heart transplantation through its integration as a standard early intervention.