Balloon counterpulsation has gained widespread acceptance as a therapy for cardiogenic shock.However,over the past four decades a parallel method of noninvasive counterpulsation,enhanced external counterpulsation (EECP),has been defined and developed.Mechanisms of benefit for this technology continue to emerge and include enhanced coronary and other key target organ perfusion beds.Other mechanisms include angiogenesis and enhanced cellular metabolism.Beyond putative mechanisms there is ample evidence for improved and sustained outcomes in patients with and without left ventricular dysfunction.