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Enhanced external counter pulsation is a noninvasive therapy that uses sequentially inflated pneumatic cuffs on the lower extremities to enhance coronary artery diastolic flow and decrease left ventricular afterload.We studied its effect on 18 patients with persistent angina despite maximal medical,surgical and catheter-based interventions.After enhanced extemal counter pulsation all subjects improved their functional class.Treatment with enhanced external counter pulsation improved functional class significantly from baseline 3.1 ± 0.6 to 1.6 ± 0.5 (p <.001).These results are consistent with the national experience.Growing physician awareness,recent Medicare approval status,and subsequent reimbursement will hopefully increase the use of this therapy.