Enhanced external counterpulsation improves cardiac function in Beagles after cardiopulmonary resuscitation

The aim of this study was to investigate the influence of enhanced external counterpulsation (EECP) on the cardiac function of beagle dogs after prolonged ventricular fibrillation. Twenty-four adult male beagles were randomly divided into control and EECP groups. Ventricular fibrillation was induced in the animals for 12 min, followed by 2 min of cardiopulmonary resuscitation. They then received EECP therapy for 4 h (EECP group) or not (control group). The hemodynamics was monitored using the PiCCO2 system. Blood gas and hemorheology were assessed at baseline and at 1, 2, and 4 h after return of spontaneous circulation (ROSC). The myocardial blood flow (MBF) was quantified by 18F-flurpiridaz PET myocardial perfusion imaging at baseline and 4 h after ROSC. Survival time of the animals was recorded within 24 h. Ventricular fibrillation was successfully induced in all animals, and they achieved ROSC after cardiopulmonary resuscitation. Survival time of the control group was shorter than that of the EECP group [median of 8 h (min 8 h, max 21 h) vs median of 24 h (min 16 h, max 24 h) (Kaplan Meyer plot analysis, P=0.0152). EECP improved blood gas analysis findings and increased the coronary perfusion pressure and MBF value. EECP also improved the cardiac function of Beagles after ROSC in multiple aspects, significantly increased blood flow velocity, and decreased plasma viscosity, erythrocyte aggregation index, and hematocrit levels. EECP improved the hemodynamics of beagle dogs and increased MBF, subsequently improving cardiac function and ultimately improving the survival time of animals after ROSC.

External Counterpulsation Reduces Beat-to-Beat Blood Pressure Variability When Augmenting Blood Pressure and Cerebral Blood Flow in Ischemic Stroke

BACKGROUND AND PURPOSE: External counterpulsation (ECP) is a noninvasive method used to enhance cerebral perfusion by elevating the blood pressure in ischemic stroke. However, the response of the beat-to-beat blood pressure variability (BPV) in ischemic stroke patients during ECP remains unknown. METHODS: We enrolled recent ischemic stroke patients and healthy controls. Changes in the blood flow velocities in bilateral middle cerebral arteries and the continuous beat-to-beat blood pressure before, during, and after ECP were monitored. Power spectral analysis revealed that the BPV included oscillations at very low frequency (VLF; <0.04 Hz), low frequency (LF; 0.04-0.15 Hz), and high frequency (HF; 0.15-0.40 Hz), and the total power spectral density (TP; <0.40 Hz) and LF/HF ratio were calculated. RESULTS: We found that ECP significantly increased the systolic and diastolic blood pressures in both stroke patients and controls. ECP decreased markedly the systolic and diastolic BPVs at VLF and LF and the TP, and the diastolic BPV at HF when compared with baseline. The decreases in diastolic and systolic BPV reached 37.56% and 23.20%, respectively, at VLF, 21.15% and 12.19% at LF, 8.76% and 16.59% at HF, and 31.92% and 23.62% for the total TP in stroke patients, which did not differ from those in healthy controls. The change in flow velocity on the contralateral side was positively correlated with the total TP systolic BPV change induced by ECP (r=0.312, p=0.035). CONCLUSIONS: ECP reduces the beat-to-beat BPV when increasing the blood pressure and cerebral blood flow velocity in ischemic stroke patients. ECP might be able to improve the clinical outcome by decreasing the beat-to-beat BPV in stroke patients, and this should be explored further in future studies.

Effect of Enhanced External Counterpulsation and Cardiac Rehabilitation on Quality of Life, Plasma Nitric Oxide, Endothelin 1 and High Sensitive CRP in Patients With Coronary Artery Disease: A Pilot Study

OBJECTIVE: To investigate the effect of enhanced external counterpulsation (EECP) on plasma nitric oxide (NO), Endothelin 1 (ET1), high sensitive C-reactive protein (HSCRP) and quality of life (QoL) in patients with coronary artery disease (CAD). METHODS: We conducted a pilot randomized clinical trial in order to evaluate plasma NO, ET1, HSCRP and QoL before and after twenty sessions of EECP (group A) and cardiac rehabilitation (CR, group B) in 42 patients with CAD (21 in each group). RESULTS: Forty-two patients (33 male and 9 female) were included in the study. The mean age was 58.2+/-10 years. The mean HSCRP was 1.52+/-0.7 in the EECP group and it was reduced to 1.27+/-0.4 after intervention. The reduction in HSCRP was not statistically significant in EECP and CR groups with p=0.33 and p=0.27, respectively. There was not significant improvement of NO, ET1, and QoL in the EECP and CR groups shortly after therapy (p>0.05). CONCLUSION: Although the short-term EECP treatment in CAD patients improved HSCRP, NO, ET1, and QoL compared with the baseline those improvements are not statistically significant. Further studies are necessary with large study groups and more sessions.

Effect of enhanced external counterpulsation [EECP] on exercise time duration and functional capacity in patients with refractory angina pectoris

Enhanced external counterpulsation [EECP] is a noninvasive technique used for patients with refractory angina pectoris. There are controversial data on the effectiveness of EECP in improving patients with refractory stable angina. The aim of the present study was to evaluate the effectiveness and safety of EECP for the treatment of patients with refractory angina pectoris. Twenty consecutive patients with refractory angina pectoris were treated with EECP, and their symptoms, echocardiographic measures, treadmill exercise test parameters, and Canadian Cardiovascular Society Class were evaluated before and immediately after EECP. The patients were followed up for 6months post treatment. There were significant differences regarding total exercise time before and after treatment [p value < 0.001]. The patients showed a significant reduction in angina classes III and IV immediately after EECP [p value < 0.001]; for most of the patients, these beneficial effects were sustained for 6 months [p value = 0.010]. There was no significant improvement in the echocardiographic parameters. EECP decreased symptoms and increased total exercise time in our study population. These beneficial effects were sustained for 6 months

Acute Myocardial Infarction with Simultaneous Occlusions of Left Anterior Descending Artery and Right Coronary Artery

Acute myocardial infarctions involving multiple coronary arteries simultaneously are infrequent and causative risk factors of the occlusions are unclear. However, severe complications arise, such as congestive heart failure or death. We report a case of two simultaneously occluded coronary arteries. A 39-year-old Korean man with simultaneous total occlusion of the left anterior descending artery and the right coronary artery presented with chest discomfort and cardiogenic shock. Immediate percutaneous coronary intervention was performed and a transvenous temporary pacemaker and intra-aortic balloon counterpulsation catheter were inserted. Through continuous effort he was discharged 8 days post intervention without any complaints.

Intervenciones de enfermería al paciente asistido con balón de contrapulsación intraaórtico / Nursing interventions to the patient assisted with intraaortic counterpulsation balloon", "_i": "

El profesional de enfermería que proporciona cuidados al paciente con balón de contrapulsación intraaórtico, también conocido como BIAC, requiere de un perfil acorde a la complejidad de la atención que se proporciona; es decir debe poseer los conocimientos, habilidades y destrezas que permitan proporcionar intervenciones seguras y efectivas en situaciones que ameriten una conducta inmediata y oportuna, sin dejar de lado el aspecto humano a cambio de un cuidado técnico, calificado y ético; éste es un desafío perenne en la recuperación cardiovascular del paciente y las unidades intensivas. Ante este panorama, el presente artículo detalla las intervenciones para el cuidado del paciente que recibe asistencia con balón de contrapulsación intraaórtico, a fin de orientar a los profesionales en su práctica diaria

The nurse who provides care to the patient with intra aortic balloon pump, also known as BIAC, requires a profile according to the complexity of the care provided, i.e. must possess the knowledge, skills and abilities allowing safe and effective interventions in situations requiring immediate and timely conduct, without neglecting the human aspect in exchange for a skilled technical and ethical care; perennial challenge in the patient’s cardiovascular recovery and intensive care units. Faced with this panorama, this article details the care interventions for the patient receiving intra aortic balloon pump assistance, to guide practitioners in their daily practice.

Intervenciones de enfermería al paciente durante la instalación de balón de contrapulsación intraaórtico / Nursing interventions to the patient during the installation of intra-aortic counterpulsation balloon", "_i": "

El balón de contrapulsación intraaórtico (BCIA) es un dispositivo que se utiliza como primera elección en cualquier protocolo de asistencia mecánica circulatoria, ya que proporciona mayor oportunidad de supervivencia en pacientes con insuficiencia coronaria severa. Por su complejidad durante la instalación, el profesional de enfermería debe poseer las competencias específicas y genéricas para proporcionar atención segura y de calidad. Ante este contexto se presenta el siguiente procedimiento como recomendación para el cuidado del paciente adulto durante la fase de instalación del BCIA.

Intra-aortic balloon counterpulsation (IABC) is a device of first choice to patients with ventricular assist providing chance of survival in patients with severe coronary insufficiency. For the complexity during installation, the nurse care needs specific and generic skills to give safe, quality care. Given this context, the following procedure presents a recommendation for adult patient care during the installation of IABC.

Study of sharing platform of web-based enhanced extracorporeal counterpulsation hemodynamic waveform data / 生物医学工程学杂志

Enhanced extracorporeal counterpulsation (EECP) information consists of both text and hemodynamic waveform data. At present EECP text information has been successfully managed through Web browser, while the management and sharing of hemodynamic waveform data through Internet has not been solved yet. In order to manage EECP information completely, based on the in-depth analysis of EECP hemodynamic waveform file of digital imaging and communications in medicine (DICOM) format and its disadvantages in Internet sharing, we proposed the use of the extensible markup language (XML), which is currently the Internet popular data exchange standard, as the storage specification for the sharing of EECP waveform data. Then we designed a web-based sharing system of EECP hemodynamic waveform data via ASP. NET 2.0 platform. Meanwhile, we specifically introduced the four main system function modules and their implement methods, including DICOM to XML conversion module, EECP waveform data management module, retrieval and display of EECP waveform module and the security mechanism of the system.

Determinación de los valores normales del índice de tei (índice de performance miocárdico) y otros parámetros ecocardiográficos doppler de la función ventricular izquierda en caninos sanos / Determination of tei index (index of myocardial performance) and other ecocadiography Doppler parameters of left ventricular function in healthy dogs

La falla cardiaca está relacionada con anormalidades en la contracción y relajación ventricular. Estudios recientes han mostrado que en la mayoría de los pacientes con insuficiencia cardiaca coexisten alteraciones de la función sistólica y diastólica, y en algunos casos la función sistólica es normal pero la falla cardiaca es generada por disfunción ventricular diastólica. El índice de performance miocárdico (tiempo de contracción isovolumétrica sumado al tiempo de eyección ventricular dividido el tiempo de eyección, “Índice de Tei”) ha sido descrito como una manera más efectiva para el análisis de la Disfunción Miocárdica Global que otros parámetros de función sistólica y diastólica. Con base en estos antecedentes, los autores determinaron el valor normal del índice de Tei para el ventrículo izquierdo en caninos sanos en la ciudad de Bogotá (2.600 msnm) con el objeto de utilizar dicho valor como índice de la función sistodiastólica. Se obtuvo un valor medio de 0,33 con un desvío estándar de 0,10. Asimismo pudo verificarse que no existe correlación con la frecuencia cardiaca, peso corporal ni con la fracción de eyección ventricular izquierdo (P<0,05)...

The compression and storage of enhanced external counterpulsation waveform based on DICOM standard / 生物医学工程学杂志

The development of external counterpulsation (ECP) local area network system and extensible markup language (XML)-based remote ECP medical information system conformable to digital imaging and communications in medicine (DICOM) standard has been improving the digital interchangeablity and sharability of ECP data. However, the therapy process of ECP is a continuous and longtime supervision which builds a mass of waveform data. In order to reduce the storage space and improve the transmission efficiency, the waveform data with the normative format of ECP data files have to be compressed. In this article, we introduced the compression arithmetic of template matching and improved quick fitting of linear approximation distance thresholding (LADT) in combimation with the characters of enhanced external counterpulsation (EECP) waveform signal. The DICOM standard is used as the storage and transmission standard to make our system compatible with hospital information system. According to the rules of transfer syntaxes, we defined private transfer syntax for one-dimensional compressed waveform data and stored EECP data into a DICOM file. Testing result indicates that the compressed and normative data can be correctly transmitted and displayed between EECP workstations in our EECP laboratory.

Enhanced external counterpulsation promotes growth cytokines-mediated myocardial angiogenesis in a porcine model of hypercholesterolemia / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Enhanced external counterpulsation (EECP) improves ischemia in patients with refractory angina pectoris, but the mechanism remains unclear. To explore the mechanisms of EECP action, we detected progenitor cells presenting any of the following markers CD34(+), CD29(+), and CD106(+).</p><p><b>METHODS</b>Growth cytokines-mediated progenitor cell mobilization and associated angiogenesis potential were assessed in a porcine model of hypercholesterolemia. Twenty-four male domestic swines were randomly assigned to 4 groups: normal diet (control, n = 6), hypercholesterolemic diet (CHOL, n = 6), hypercholesterolemic diet with administration of recombinant human granulocyte colony-stimulating factor (rhG-CSF) (rhG-CSF, n = 6), and hypercholesterolemic diet with EECP treatment (EECP, n = 6). EECP was applied 2 hours every other day for a total of 36 hours. Serum levels of vascular endothelial growth factor (VEGF) and granulocyte colony-stimulating factor (G-CSF), peripheral blood progenitor cell counts, level of regional angiogenesis, and expression of VEGF and stromal cell derived factor 1alpha (SDF-1alpha) in porcine myocardium were assessed, respectively.</p><p><b>RESULTS</b>A porcine model of hypercholesterolemia-induced arteriosclerosis was successfully established. There was no significant difference in serum levels of VEGF among the four groups. The serum levels of G-CSF in the EECP group increased significantly at week 15 and week 18 ((38.3 +/- 5.6) pg/ml at week 15 vs (26.2 +/- 3.7) pg/ml at week 12, P < 0.05, and (46.9 +/- 6.1) pg/ml at week 18 vs (26.2 +/- 3.7) pg/ml at week 12, P < 0.01). The serum levels of G-CSF in group 3 increased also significantly after receiving rhG-CSF injection for five days ((150 +/- 13.9) pg/ml at week 18 vs (24.8 +/- 5.4) pg/ml at week 12, P < 0.01). Compared to other groups and other time points, progenitor cell counts increased significantly after 2-hour EECP treatment (108 +/- 13 vs 26 +/- 6 per 10(5) leukocytes, P < 0.01), but not at week 18. The progenitor cell counts also increased significantly after subcutaneous injection of rhG-CSF for five days compared to the week 12 (baseline) (180 +/- 21 vs 25 +/- 7 per 10(5) leukocytes, P < 0.01). There was no significant difference among the four groups at other time points. Moreover, the expression of VEGF and SDF-1alpha and the level of regional angiogenesis in myocardium increased significantly in both EECP and rhG-CSF groups.</p><p><b>CONCLUSIONS</b>The results demonstrated that EECP could facilitate angiogenesis in the myocardium of atherosclerotic swines by increasing endogenous G-CSF, inducing an enhanced mobilization of progenitor cells and augmenting myocardial expression of VEGF and SDF-1alpha.</p>

Effect of chronic enhanced external counterpulastion on gene expression profiles of arterial endothelial cells of pigs fed with high-cholesterol diet / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of chronic enhanced external counterpulastion (EECP) on gene expression profiles of arterial endothelial cells (ECs) of pigs fed with high-cholesterol diet.</p><p><b>METHODS</b>Eight male pigs were fed with high-cholesterol diet for 12 weeks to induce arteriosclerosis and subjected to EECP for accumulative 36 h (2 h every other day for 18 sessions). Another 8 pigs on cholesterol-enriched diet and 6 normally fed pigs served as the arteriosclerosis model group and normal control group, respectively, and the high-cholesterol diet was maintained until the end of EECP treatment. The coronary artery was then isolated for transmission electro microscopy, and the abdominal aorta was observed using Sudan III staining. The gene expression profiles in ECs from the thoracic aorta using cDNA microarrays.</p><p><b>RESULTS</b>Macrophages and foam cells were detected beneath the ECs in the coronary artery of pigs in the model group, but not in the other two groups. The ratios of Sudan III-positive area in the celiac aorta were significantly lower in normal control and EECP groups than in the model control group (P<0.05). Compared with the normal control group, the gene expressions of integrins-beta1 and CTGF were up-regulated in the model group. Compared with the model group, the expressions of integrins-beta1, CTGF and VCAM-1 were down-regulated and eNOS up-regulated in EECP group.</p><p><b>CONCLUSION</b>Chronic EECP may reduce endothelial injury, down-regulate the gene expression level of integrin-beta1, CTGF and VCAM-1, lower cholesterol uptake and attenuate arterial endothelial inflammation to protect the pigs fed with high-cholesterol diet from arteriosclerosis.</p>

Contrapulsación intraaórtica y determinantes de la poscarga ventricular: estudio experimental en un modelo animal. Cambios en resistencias periféricas, impedancia y elasticidad aórtica y características propagatorias del pulso durante latidos asistidos / Intra-aortic contrapulsation and determinants of ventricular after load: experimental study an animal model

Introducción: los beneficios de la asistencia con balón de contrapulsación intraaórtica (CIAO) se atribuyen principalmente a los efectos hemodinámicos (cambios en presión y resistencias periféricas), determinados por el inflado-desinflado del balón. La poscarga dinámica ventricular depende de la elasticidad e impedancia aórticas y de la velocidad de propagación y nivel de reflexión periférica de la onda de pulso. Los efectos de la CIAO sobre los determinantes de la poscarga dinámica o los mecanismos de los mismos, o ambos, no han sido caracterizados. Objetivo: caracterizar los cambios en los determinantes de la poscarga estática y dinámica ventricular que ocurren durante la CIAO y los mecanismos (pasivos o activos, o ambos) que los determinan. Material y método: en ocho ovinos se midió flujo, diámetro y presión aórtica, en latidos basales (control) y en latidos asistidos (postaumentados), durante CIAO 1:2. Se calculó la resistencia periférica, la impedancia y elasticidad aórticas, la velocidad de propagación del pulso, el coeficiente de reflexión periférico y el índice de desadaptación propagatorio.

Hyper-echoic plaque with high attenuation in intravascular ultrasound may predict slow flow during percutaneous coronary intervention.

One patient with acute inferior wall myocardial infarction underwent percutaneous coronary intervention following intravenous thrombolysis. Intravascular ultrasound (IVUS) before stenting revealed huge plaque burden with high attenuation underneath the hyper-echoic eccentric plaque surface. Stent deployment resulted in slow flow, which was managed with intra-aortic balloon counter-pulsation. His another lession in the mid left anterior descending artery showing eccentric hypo-echoic plaque with neither hyper-echoic surface nor high attenuation was successfully stented without causing slow flow.

A study on noise controlling of the electromagnetic valve in external counterpulsation devices / 中国医疗器械杂志

Noise of ECP (external counterpulsation) comes from the frequent movement of the electromagnetic valve iron core hitting the top of the valve body and the orifice of the bottom, and the high pressure and large air stream rubbing the orifice. This article studies the method to reduce mechanical noise of the electromagnetic valve core, that is to reduce the above movement energy and the hitting force. The method is used in ECP devices with grafying results. This noise controlling technology may reduce the noise of the electromagnetic valve from higher than 50dB to less than 25dB.

Establishment of a pig model of chronic ally enhanced external counterpulsation / 南方医科大学学报

<p><b>OBJECTIVE</b>To establish a pig model of chronic external counterpulsation.</p><p><b>METHODS</b>Twelve pigs were anaesthetized with sodium pentobarbital (< or =30 mg/kg.b.w.) and 846 mixture (< or =0.1 ml/kg.b.w.) and counterpulsed in a lateral position for 2 h every two days (totally 36 h) with 0.025 to 0.04 MPa/cm(2) pressure.</p><p><b>RESULTS</b>External counterpulsation was successfully completed in all the animals. Combined administration of sodium pentobarbital and 846 mixture resulted in good anesthetic effect with reduced anesthetic dosage and minimal side effect on the viscera (the liver, kidney and heart, etc).</p><p><b>CONCLUSION</b>The pig model of chronic external counterpulsation has been successfully established. Combined use of sodium pentobarbital and 846 mixture is recommended for chronic external counterpulsation.</p>

Effects of external counterpulsation on shear stress and production of nitric oxide and cGMP in canines with myocardial infarction / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effects of external counterpulsation (ECP) on shear stress and signal transduction in canines with myocardial infarction.</p><p><b>METHODS</b>Nineteen healthy dogs were randomly divided into control, ischemia, and ischemia plus ECP groups. Myocardial infarction was induced in the latter two groups by ligation of the left anterior descending artery (LAD). Serum and aorta NO levels of the dogs were determined by modified nitrate reductase method, and serum and aorta cyclic guanosine monophosphate (cGMP) levels by radioimmunoassay.</p><p><b>RESULTS</b>The shear stress in the truncus brachiocephalicus decreased after LAD ligation, but increased significantly after 2 h of ECP treatment. Serum and aorta NO levels in ECP and control groups were significantly higher than those in the ischemic group (P<0.05). Serum and aorta cGMP levels in control group and ECP group after LAD ligation were also significantly higher than those in the ischemic group (P<0.05).</p><p><b>CONCLUSION</b>ECP can increase the shear stress and increase NO and cGMP levels in dogs with myocardial ischemia, which might be an important mechanism of ECP for protection of the ischemic myocardium.</p>

Effects of enhanced external counterpulsation in atherosclerosis and NF-kappaB expression: a pig model with hypercholesterolemia / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the effects of enhanced external counterpulsation (EECP) on the vascular morphology, and endothelial function using experimentally induced hypercholesterolemic pigs.</p><p><b>METHODS</b>Thirty five male pigs were randomly divided into three groups: 7 normal control animals, 11 hypercholesterolemic animals, and 17 hypercholesterolemic animals receiving EECP. Serum cholesterol was measured. The coronary arteries and aortas were sampled for histopathologic and ultrastructural examination. The NF-kappaB protein expression of porcine coronary arteries was investigated by immunofluorescence.</p><p><b>RESULTS</b>Compared with the normal controls, serum cholesterol levels were significantly higher in the hypercholesterolemic animals with or without EECP. The plaque/intimal area ratio of the aorta decreased significantly in animals receiving EECP [(3.33 +/- 2.40)%, versus (12.03 +/- 7.12)% in those without EECP, P < 0.05]. Lipid deposition, endothelial damage and proliferation of smooth muscle cells were less severe in animals receiving EECP than those not. Moreover, activation and expression of NF-kappaB also decreased significantly (P < 0.05) in animals receiving EECP.</p><p><b>CONCLUSIONS</b>EECP improves the morphology and function of vascular endothelium, and retards the development and progression of atherosclerosis, likely through the inhibition of NF-kappaB signaling pathway.</p>