We studied the effect of enhanced external counterpuisation (EECP) in 23 consecutive patients with stable angina pectoris who had a positive dobutamine stress echocardiogram.After EECP,stress-induced wall motion score (WMS) improved by > or =2 grades in 43% of the patients (n =10); the average improvement was 5.3 +/-3.8 compared with-0.6 +/-3.0 in the remaining 13 patients (p =0.007).The diastolic/systolic augmentation ratio increased by 217% in response to the full course of EECP (p =0.0002) among patients with improved WMS,and by 71% (p =0.004) among the other patients; the increase was greater among patients with improved WMS than among patients with no improvement (p =0.01).After EECP,Canadian Cardiovascular Society angina class improved from 3.1 +/-0.6 to 2.2 +/-0.7 (p <0.0001) in the entire group and exercise capacity increased by 73 seconds (p =0.0002) in patients who were able to exercise (n =18).