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.

Pulsatile blood flow in arteries: An analytical and numerical study based on the Womersley algorithm / 医用生物力学

Objective To conduct a comprehensive study on pulsatile blood flow in arteries by proposing a convenient theoretical research system for hemodynamics. Methods Based on Womersley algorithm for fully developed pulsatile flow, numerical algorithm was introduced to establish the solving and analytical system of hemodynamics based on flow rate in arteries during one cardiac cycle. The flow rate of carotid artery in pig was measured under three blood flow states: the ideal state with a sinusoidal inflow waveform, the normal physiological state and the enhanced external counterpulsation (EECP) state for comprehensive hemodynamic research. Results Important hemodynamic parameters such as the axial speed vector, the wall shear stress (WSS), and the oscillatory shear index (OSI) during one cardiac cycle under the mentioned three flow states were solved respectively. The waveform of flow rate had a certain effect on WSS distributions and OSI level; the EECP performance obviously resulted in a significant increase in the level of WSS (WSS peak in particular) and OSI. Conclusions The solving system developed in this paper can be used for hemodynamics study conveniently and effectively. One of the most important hemodynamic mechanisms that lead to EECP’s good clinical effect may lie in its promotion to WSS level under physiological state, but the effect of OSI on endothelial function of the artery might much smaller than WSS itself; therefore, OSI may not be an ideal hemodynamic index for predicting the lesion of atherosclerosis.

Effect of enhanced external counterpulsation therapy on myeloperoxidase in lowering cardiovascular events of patients with chronic heart failure.

Background: Chronic heart failure (CHF) is a slowly progressive disease with high morbidity and mortality; therefore, the management using pharmacological treatments frequently fails to improve outcome. Enhanced external counterpulsation (EECP), a non-invasive treatment, may serve as alternative treatment for heart failure. This study was aimed to evaluate the influence of EECP on myeloperoxidase (MPO) as inflammatory marker as well as cardiac events outcome. Methods: This was an open randomized controlled clinical trial on 66 CHF patients visiting several cardiovascular clinics in Manado between January-December 2012. The subjects were randomly divided into two groups, i.e. the group who receive EECP therapy and those who did not receive EECP therapy with 33 patients in each group. Myeloperoxidase (MPO) as inflammatory marker was examined at baseline and after 6 months of observation. Cardiovascular events were observed as well after 6 months of observation. Unpaired t-test was use to analyze the difference of MPO between the two groups, and chi-square followed by calculation of relative risk were used for estimation of cardiovascular event outcomes. Results: MPO measurement at baseline and after 6 months in EECP group were 643.16 ± 239.40 pM and 422.31 ± 156.26 pM, respectively (p < 0.001). Whereas in non EECP group, the MPO values were 584.69 ± 281.40 pM and 517.64 ± 189.68 pM, repectively (p = 0.792). MPO reduction was observed in all patients of EECP group and in 13 patients (48%) of non-EECP group (p < 0.001). Cardiovascular events were observed in 7 (21.21%) and 15 (45.45%) of patients in EECP and non-EECP groups, respectively (p = 0.037). Conclusion: EECP therapy significantly decreased the level of MPO as inflammatory marker and this decrease was correlated with the reduction of cardiovascular events in CHF patients.

Therapeutic effects of Enhanced External Counter Pulsation (EECP) on clinical symptoms, echocardiographic measurements, perfusion scan parameters and exercise tolerance test in coronary artery disease patients with refractory angina.

Background: The purpose of this study was finding relationship between the therapeutic effects of Enhanced External Counterpulsation on treatment resistant angina among the patients, who are unsuitable for invasive interventions. Aims & Objective: To study the therapeutic effects of Enhanced External Counter Pulsation (EECP) on clinical symptoms, echocardiographic measurements, perfusion scan parameters and exercise tolerance test in coronary artery disease patients with refractory angina. Material and Methods: In an interventional study 50 patients (34 men and 16 women) under EECP therapy were investigated for one year. This machine is composed of three pairs of cuffs which work by attaching cuffs to lower limbs and it is contracted during diastole from distal to proximal and makes pressure to vessels of lower limbs. Treatment effects of EECP on clinical signs were evaluated on the base of Canadian cardiovascular society classification for angina severity, drugs consumption and SF36 quality of life questionnaire. Para clinical assessments including echocardiography, perfusions scan and exercise tolerance test parameters were also assessed prior to EECP, at the end of the treatment and at 12 months thereafter. Any differences in background measurements were recorded and analyzed. Results: Decrement of angina severity and improvement of life quality before and after one month EECP therapy was significant (p<0.001, p=0.01). The rate of nitrate consumption and other medications causes no significant difference concerning dosage decrease (p>0.05). There was significant difference between ejection fraction of before, one month and one year after treatment only in severe IHD (p=0.016, p=0.038, respectively). Left ventricle end diastolic and end systolic diameters were also significantly decreased after one month (p= 0.031), and this improvement remained up to one year. Difference between ischemia severity in perfusion scan before and one month afterwards was significant as well (p= 0.044). The exercise tolerance test duration after one month also increased (p<0.001) and did not change statistically after one year. Conclusion: This study demonstrated that EECP is a useful method, while effective and safe for patients with severe refractory angina pectoris resistant to drug therapy and aggressive interventions such as PCI or CABG are not suitable.

Effects of long-term enhanced external counterpulsation on endothelium-dependent and endothelium-independent vasorelaxation of the carotid arteries in atherosclerotic pigs / 中华急诊医学杂志

Objective To explore the effect of long-term enhanced external counterpulsation(EECP)on endothelium-dependent and endothelium-independent vasorelaxation in the carotid arteries of atherosclerotic piss. Method Totally 18 20-day-old male infant pigs were randomly divided into 3 groups according to feeding given: the normal[control group(n=6),the hypercholesterolemic control group(n=6)and the hypereholesterolemic +EECP group(n=6).Porcine model of hypercholesterolemia was made by feeding high-cholesterol diet.After EECP for 36 hours in the hypercholesterolemic+EECP group(n=6),carotid arterial rings were harvested from all animals and their vaso-relaxation response to different dose of Acetylchofine(Ach)and Sodium nitroprusside (SNP)were detected,respectively.Results As the dose of Ach varying between 10-8 mol/L and 10-5mol/L, endothelium-dependent vasorelaxation ratio of hypereholesterolemic piss with or without EECP treatment was significantly lower than that of the normal control group(P＜0.05),however,endothehum-dependent vasorelax- ation ratio in pigs with EECP treatment was obviously higher compared with hypereholesterolemic pigs without EECP treatment(P＜0.05)as the Ach ranged from 10-7 mol/L to 10-5mol/L.Similarly,as the concentration of SNP ranged fiun 10-8 mol/L to 10-5 mol/L.endothelium-independent vasorelaxafion ratio of both the hypercholesterolemic control group and the hypercholesterolemic+EECP group were significantly lower than that of the normal control group(P＜0.05),and end othelium-independent vasorelaxation ratio of the hypercholesterolemic+EECP group was significantly higher than that of the hypercholesterolemic control group (P＜0.05).Condusions Long-term EECP improves the impaired endothelium-dependent and endothelium independent vasorelaxalion function resulting from atherosclerosis.

The Past, Present and Future of External Counterpulsation / 中山大学学报(医学科学版)

Enhanced external counterpulsation(EECP) was developed in our laboratory and applied in clinical setting since 1976. Before the year of 1990, the mechanism of this treatment was supposed to promoting collateral circulation by increasing diastolic pressure during counterpulsation. According to a series of investigations, we discovered and confirmed that the flow shear stress were increased obviously during EECP, regulating a series of reaction of shear stress responsive elements, inducing vascular endothelial cell (VEC) repair mechanism, improving VEC function, all of which contribute to the inhibition of development of atherosclerosis. A new generation of EECP device was designed based on the advances above and aimed at promoting the aterial flow shear stress more effectively in turn to protect vascular endothelium.