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Objective. By detecting the levels of external counterpulsation combined with exercise therapy on the levels of moesin, angiopoietin-like protein2 (Angptl 2), angiopoietin-like protein (Angptl 3), hypoxia inducible factor-1α (HIF-1α), and RNA-34a (miR-34a) in patients with coronary artery occlusive disease, the effect of external counterpulsation combined with exercise therapy on the establishment of occluded coronary collateral circulation was studied. Methods. A retrospective analysis of 166 patients with coronary heart disease was confirmed by coronary angiography results that at least one coronary artery (anterior descending branch, circumflex branch, and right coronary artery) was completely occluded and was classified into the control group (routine medication) and the treatment group (routine drug therapy plus exercise therapy and external counterpulsation) according to the treatment plan of the patient. The serum levels of moesin, Angptl 2, Angptl 3, and HIF-1α were detected by enzyme-linked immunosorbent assay (ELISA) test. The index of microcirculatory resistance (IMR) and coronary flow reserve (CFR) of the two groups of patients were measured before and after 2 weeks of treatment. The formation of collateral circulation was analyzed according to the Rentrop classification method. Results. After treatment, the IMR levels of the two groups were significantly decreased, and the CFR levels were significantly increased. The decrease of IMR level and the increase of CFR level in the experimental group were better than those in the control group ( P < 0.05 ). There was no significant difference in the positive detection rate of moesin antibody between the two groups, but the OD detection value of the treatment group decreased significantly ( P < 0.05 ). The levels of Angptl 2, Angptl 3, and miR-34a in the treatment group were lower than those in the control group, while the relative expression of HIF-1α was higher than that in the control group. The difference was statistically significant ( P < 0.05 ). External counterpulsation combined with exercise therapy improved the formation rate of collateral circulation ( P < 0.05 ). Conclusions. External counterpulsation combined with exercise therapy can reduce moesin antibody, Angptl 2, Angptl 3, and miR-34a levels increase HIF-1α levels, and promote the establishment of occluded coronary collateral circulation.

Enhanced external counterpulsation (EECP) is a non-invasive treatment modality capable of treating a variety of ischemic diseases. Currently, no effective methods of predicting the patient-specific hemodynamic effects of EECP are available. In this study, a personalized 0D-1D model of the cardiovascular system was developed for hemodynamic simulation to simulate the changes in blood flow in the EECP state and develop the best treatment protocol for each individual.A 0D-1D closed-loop model of the cardiovascular system was developed for hemodynamic simulation, consisting of a 1D wave propagation model for arteries, a 0D model for veins and capillaries, and a one-fiber model for the heart. Additionally, a simulation model coupling EECP with a 1D model was established. Physiological data, including the blood flow in different arteries, were clinically collected from 22 volunteers at rest and in the EECP state. Sensitivity analysis and a simulated annealing algorithm were used to build personalized 0D-1D models using the clinical data in the rest state as optimization objectives. Then, the clinical data on EECP were used to verify the applicability and accuracy of the personalized models.The simulation results and clinical data were found to be in agreement for all 22 subjects, with waveform similarity coefficients (r) exceeding 90% for most arteries at rest and 80% for most arteries during EECP.The 0D-1D closed-loop model and the optimized method can facilitate personalized modeling of the cardiovascular system using the data in the rest state and effectively predict the hemodynamic changes in the EECP state, which is significant for the numerical simulation of personalized hemodynamics. The model can also potentially be used to make decisions regarding patient-specific treatment.

Aims Enhanced external counterpulsation (EECP) is a non-invasive treatment (35 one-hour sessions) for patients with refractory angina pectoris (RAP). To avoid interruption of treatment, more knowledge is needed about potential adverse events (AE) of EECP and their appropriate management. To describe occurrence of AE and clinical actions related to EECP treatment in patients with RAP and compare the distribution of AE between responders and non-responders to treatment. Methods and results A retrospective study was conducted by reviewing medical records of 119 patients with RAP who had undergone one EECP treatment and a 6-min-walk test pre- and post-treatment. Sociodemographic, medical, and clinical data related to EECP were collected from patients’ medical records. An increased walking distance by 10% post-treatment, measured by 6-min-walk test, was considered a responder. The treatment completion rate was high, and the occurrence of AE was low. Adverse events occurred more often in the beginning and gradually decreased towards the end of EECP treatment. The AE were either device related (e.g. muscle pain/soreness) or non-device related (e.g. bradycardia). Medical (e.g. medication adjustments) and/or nursing (e.g. extra padding around the calves, wound dressing) actions were used. The AE distribution did not differ between responders (n = 49, 41.2%) and non-responders. Skin lesion/blister occurred mostly in responders and paraesthesia occurred mostly in non-responders. Conclusion Enhanced external counterpulsation appears to be a safe and well-tolerated treatment option in patients with RAP. However, nurses should be attentive and flexible to meet their patients’ needs to prevent AE and early termination of treatment.

Balloon pumps are employed to assist cardiac function in cases of acute myocardial infarction, ventricular arrhythmias, cardiogenic shock, unstable angina, refractory ventricular failure, or cardiac surgery. Counterpulsation, through increasing the diastolic pressure and reducing the systolic pressure, increases coronary perfusion and assists the heart to pump more blood at each contraction. An expanding-contracting balloon, modifying the Poiseuille flow in a straight circular duct, is examined in this study. The balloon is spheroid-shaped, with the length of its minor axis, which is perpendicular to the flow direction, changing in time following a sinusoidal law. The inlet flow volume rate is steady while the rate that the fluid volume leaves the duct varies in time due to the presence of the balloon. For a pulsation frequency of 60 pulses/min, the pressure difference across the pulsating balloon exhibits significant phase lagging behind the outflow volume waveform. The outlet pressure depends on the balloon radius oscillation amplitude and is computed for a range of such. The flow field around the spheroid, periodically expanding-contracting balloon in the steady flow stream is presented, in which the exact pattern of the gradual downstream intensification of the flow pulsation alongside the spheroid body is also identified.

This study aimed to develop a sensitive index from transcranial Doppler (TCD) signals for quantitatively evaluating the effects of long-term external counterpulsation (ECP) treatment on stroke rehabilitation. We recruited 27 patients with unilateral ischemic stroke and a good acoustic window within 7 days of stroke onset. 15 of them received 35 daily 1-hour ECP treatment (ECP group) and the others underwent conventional therapy without ECP treatment (No-ECP group). We monitored blood flow in middle cerebral arteries on both sides by TCD, and analyzed them via discrete wavelet analysis method. The overall changes of National Institutes of Health Stroke Scale (NIHSS) and Barthel Index were assessed. A ‘big-wave’ phenomenon was observed in TCD signals of patients in ECP group after 35 days’ treatment, with significant fluctuation in frequency interval from 0.010 to 0.034 Hz as main feature. A new index, which was denoted as ${I}$ , was derived from this phenomenon. The ${I}$ was significantly higher for patients in ECP group than that for patients in No-ECP group after 35-days’ treatment ( ${P} 0.01). And the ${I}$ was positively correlated with NIHSS change in ECP group ( ${P} ). The new index could be used as an effective indicator for evaluating enhancement of endothelial metabolism and neurogenic activity after long-term ECP treatment.

ObjectiveTo evaluate the efficacy of enhanced external counterpulsation (EECP) in the prevention of contrast-induced nephropathy (CIN) in patients with combined chronic kidney disease (CKD) and diabetes mellitus (DM) by comparing the changes in renal function-related indicators in patients before and after coronary angiography (CAG) or percutaneous coronary intervention (PCI).MethodsThere were 230 subjects consecutively included in the study. Of these, 30 cases with DM underwent rehydration therapy, and 200 cases underwent EECP therapy in addition to rehydration therapy, comprising 53 patients with DM and 147 patients without. All the patients were tested to measure the renal function indicators before and after CAG/PCI.ResultsThe postoperative results of blood urea nitrogen (BUN), serum creatinine (Scr), estimated glomerular filtration rate (eGFR), B2 microglobulin, and high-sensitivity C-reactive protein in the three groups showed a statistically significant difference (P < 0.05). After EECP therapy, patients with DM showed a significant decrease in BUN (9.1 ± 4.2 vs. 7.2 ± 3.0, t = 3.899, P < 0.001) and a significant increase in eGFR (41.5 ± 12.7 vs. 44.0 ± 15.6, t = −2.031, P = 0.047), while the patients without DM showed a more significant difference (P < 0.001). Patients with DM showed a lower percentage of elevated Scr (66.7% vs. 43.4%, P = 0.042), a higher percentage of elevated eGFR (30.0% vs. 52.8%, P = 0.044), and a lower incidence of CIN (16.7% vs. 3.8%, P = 0.042) after EECP therapy.ConclusionTreatment with EECP can reduce Scr in patients with combined CKD and DM post CAG/PCI, increase eGFR, and decrease the incidence of CIN.

Venous diseases encompass a large spectrum of abnormalities in the venous system with complaints, such as aching and swelling. Enhanced external counterpulsa-tion, proven safe and effective in patients with coronary artery disease and chronic heart failure, is a technique that increases venous return and augments diastolic blood pres-sure. This study assessed the effects of enhanced external counterpulsation on symp-toms of venous disease using the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms questionnaire.This study was designed prospectively for evaluating venous symptoms before and after enhanced external counterpulsation treatment. The study population con-sisted of 30 consecutive patients who were admitted to the cardiology clinic. The Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms ques-tionnaire was applied to assess venous symptoms one day before and after enhanced external counterpulsation treatment.The mean age of the patients was 64.62 ± 9.67 years. After 35 hours of enhanced external counterpulsation, 28 patients (93%) had at least 1 New York Heart Association functional class reduction compared with baseline and 43% of patients had 2 New York Heart Association functional classes improvement. The New York Heart Association class significantly decreased after enhanced external counterpulsation treatment (P.001). There was a significant improvement in their swelling and night cramps symptoms compared with baseline (P.001 and P = .05, respectively). Also, The left ventricular ejec-tion fraction significantly increased after the enhanced external counterpulsation treat- ment (P = .02).The findings obtained in the present study suggested that patients treated with enhanced external counterpulsation showed a significant reduction in swelling and night cramps symptoms. Although the total VEIN score did not change after the enhanced external counterpulsation procedure, improvement in swelling and night cramps under-lines the beneficial effects of enhanced external counterpulsation through the venousvascular territory.

BACKGROUND Patients with refractory angina pectoris experience recurrent symptoms that limit their functional capacity, including psychological distress and impaired health-related quality of life (HRQoL), despite optimized medical therapy. Enhanced external counterpulsation (EECP) is an evidence-based alternative noninvasive treatment. Although physical well-being and mental well-being are equally important components of health, few studies have investigated the psychological effects of EECP in patients with refractory angina pectoris. OBJECTIVE The aim of this study was to evaluate the effects of EECP treatment in patients with refractory angina pectoris regarding medication profile, physical capacity, cardiac anxiety, and HRQoL. METHODS This quasi-experimental study with 1-group pretest-posttest design includes a 6-month follow-up of 50 patients (men, n = 37; mean age, 65.8 years) who had undergone 1 EECP course. The following pretreatment and posttreatment data were collected: medication use, 6-minute walk test results, functional class according to the Canadian Cardiovascular Society, and self-reported (ie, questionnaire data) cardiac anxiety and HRQoL. In addition, the questionnaires were also completed at a 6-month follow-up. RESULTS After EECP treatment, patients used significantly less nitrates (P < .001), walking distance increased on average by 46 m (P < .001), and Canadian Cardiovascular Society class improved (P < .001). In addition, all but 1 subscale of cardiac anxiety and all HRQoL components improved significantly (P < .05). The positive effects for cardiac anxiety and HRQoL were maintained at the 6-month follow-up. CONCLUSIONS Enhanced external counterpulsation treatment resulted in reduced symptom burden, improved physical capacity, and less cardiac anxiety, leading to increased physical activity and enhanced life satisfaction for patients with refractory angina pectoris. Enhanced external counterpulsation treatment should be considered to improve the life situation for these patients.

Although heart transplant is the preferred solution for patients suffering from heart failures, cardiac assist devices remain key substitute therapies. Among them, aortic augmentation using dielectric elastomer actuators (DEAs) might be an alternative technological application for the future. The electrically driven actuator does not require bulky pneumatic elements (such as conventional intra-aortic balloon pumps) and conforms tightly to the aorta thanks to the manufacturing method presented here. In this study, the proposed DEA-based device replaces a section of the aorta and acts as a counterpulsation device. The feasibility and validation of in vivo implantation of the device into the descending aorta in a porcine model, and the level of support provided to the heart are investigated. Additionally, the influence of the activation profile and delay compared to the start of systole is studied. We demonstrate that an activation of the DEA just before the start of systole (30 ms at 100 bpm) and deactivation just after the start of diastole (0-30 ms) leads to an optimal assistance of the heart with a maximum energy provided by the DEA. The end-diastolic and left ventricular pressures were lowered by up to 5% and 1%, respectively, compared to baseline. The early diastolic pressure was augmented in average by up to 2%.

Based on the changes in phase characteristics of blood flow and pressure, enhanced external counterpulsation (EECP) reduces cardiac load and improves cerebral perfusion in patients with cerebrovascular diseases. However, increased cerebral blood flow (CBF) is associated with the rise in blood pressure and its complications. Increased EECP frequency is a valuable solution when combined with the electrical equivalent impedance characteristics of the lumped parameter model (LPM) of the human blood circulation system. Herein, to investigate the effect of different EECP frequencies on CBF perfusion, an LPM was established with cardiopulmonary circulation and eight systemic blood flow units with cerebral autoregulation module of ischemic stroke patients. Then, using differential equations, we analyzed those parameters through hemodynamic simulations in four EECP modes. With related influencing parameters remaining constant, we adjusted the pressure frequency of EECP and found that when compared to the traditional sequential EECP mode, the relative increase rate of CBF was 16.68%, 18.95%, and 21.21% from 1 to 3 Hz, respectively. This study validates the effect of improving blood prefusion with increasing EECP frequency through numerical analysis.

Since the publication of a neutral trial on the effects of aortic counterpulsation in patients with myocardial infarction complicated by cardiogenic shock, the use the intra-aortic balloon pump (IABP) has decreased tremendously, not only in cardiology but also in cardiac surgery. Unfortunately, the clinical results of other mechanical circulatory support technologies are more than disappointing and often show an unacceptably high mortality. In contrast, several recent observational trials suggest that the IABP may still be useful in patients with cardiogenic shock due to myocardial infarction or acute decompensated heart failure. Additionally, meta-analyses and a clinical guideline highlight the beneficial effects of preemptive use of the IABP in cardiac surgery on clinical outcomes. The present chapter gives an overview on technological aspects of aortic counterpulsation, on recent data in patients with cardiogenic shock and patients with reduced myocardial function undergoing cardiac surgical procedures, and shows that the IABP is still a useful tool for the management of the patients with severely reduced myocardial function in the field of cardiology and in the patient undergoing high-risk cardiac surgical procedures.

The treatment benefits of enhanced external counterpulsation (EECP) heavily depends on hemodynamics. Global hemodynamics of EECP can cause blood flow redistribution in the circulatory system whereas local hemodynamic effects act on vascular endothelial cells (VECs). Local hemodynamic effects of EECP on VECs are important in the treatment of atherosclerosis, but currently cannot be not evaluated. Herein we aim to establish evaluation models of local hemodynamic effects based on the global hemodynamic indicators.We established 0D/3D geometric multi-scale hemodynamic models of the coronary and cerebral artery of two healthy individuals to calculate the global hemodynamic indicators and the local hemodynamic effects. Clinical EECP trials were performed to verify the accuracy of the multi-scale hemodynamic model. The global hemodynamic indicators included diastolic blood pressure/systolic blood pressure (Q = D/S), mean arterial pressure (MAP), internal carotid artery flow (ICAF) and cerebral blood flow (CBF), whereas local hemodynamic effects focused on time-averaged wall shear stress (TAWSS). The correlation between these indicators was analyzed via Pearson correlation coefficient. Significantly related indicators were selected for curve-fitting to establish evaluation models of the coronary and cerebral artery. Moreover, clinical data of a coronary heart disease patient and a cerebral ischemic stroke patient were collected to verify the effectiveness of the application of the established evaluation models to real patients.For coronary artery, TAWSS was correlated to Q = D/S and ICAF (P 0.05), whereas for cerebral artery, TAWSS was correlated to MAP and CBF (P 0.05). The mean square error (MSE) between the evaluated values using evaluation model and the calculated values using 0D/3D model of TAWSS of the coronary and cerebral artery were 5.4% and 1.0%, respectively. The MSE of evaluation model applied to real patients was greater than that applied to healthy individuals, but within an acceptable range.The presented error demonstrated validity and accuracy of the evaluation models in clinical patients. Based on the evaluation models, global hemodynamic indicators could be used to evaluate the local hemodynamic effects under the current counterpulsation mode. With TAWSS range of 4-7 Pa as the target range, EECP strategies can further be optimized.

Individual shear rate therapy (ISRT) evolved from external counterpulsation with individual treatment pressures based on Doppler ultrasound measurements. In this study, we assessed the effect of ISRT on blood pressure (BP) in patients with coronary artery disease (CAD). Eighty-four patients with symptomatic CAD were included in the study. Forty-one patients were enrolled for 6 weeks, comprising 30 sessions of ISRT; 43 age- and sex-matched patients represented the control group. The 24-h BP was determined by measuring the pulse transit time before and after 6 weeks of ISRT or the time-matched control. Participants were divided into three groups according to the 24-h BP before treatment: BP1 130/80 mmHg (normotensive); BP2 ≥ 130-140/80 mmHg (moderate hypertensive); BP3 140/80 mmHg (hypertensive). After 30 sessions of ISRT, the 24-h BP decreased significantly, whereas no changes were observed in the controls. The BP-lowering effect correlated with the 24-h BP before therapy (systolic: r = -0.78; p 0.001; diastolic: r = -0.76; p 0.001). In BP1, the systolic BP decreased by 4.3 ± 6.4 mmHg (p = 0.011), and the diastolic BP decreased by 4.8 ± 11.0 mmHg (p = 0.032); in BP2, the systolic BP decreased by 13.3 ± 7.5 mmHg (p 0.001), and the diastolic BP decreased by 5.0 ± 7.5 mmHg (p = 0.002); and in BP3, the systolic BP decreased by 22.9 ± 11.4 mmHg (p 0.001), and the diastolic BP decreased by 9.1 ± 9.5 mmHg (p = 0.003). Our findings demonstrate that ISRT reduces BP in patients with CAD. The higher the initial BP the greater the lowering effect.

External counterpulsation (ECP), an electrocardiogram-led sequential compression of lower limbs, has been recently proposed for sports recovery, but research is scant. This study examined the effects of an ECP session upon neuromuscular function (vertical jump and torque/velocity characteristics), biochemical responses (creatine kinase, cortisol, testosterone, alpha-amylase and immunoglobulin-A), and muscle soreness (visual analogue scale) following high-intensity exercise. Twenty-one male team sport athletes (age: 21.6±3.4 yrs; height: 182.7±7.3 cm; body mass: 82.7±9.3 kg) recovered from the fatiguing exercise using either ECP or rest. Data collection was conducted at three separate time points: upon arrival (Pre), post-recovery (Post), and 24 h post-recovery (24hPost). Significant main effects for time were observed for increased torque/velocity slope and for decreased isometric extension peak torque (p

Aim: to develop a new modified index for the assessment of bioenergy heart in conditions of heart failure. To assess the energy of the heart when using systems to bypass the left ventricle of the heart using non-pulsed flow pumps. To consider the fundamental advantage of non-pulsating flow pumps with the generation of a pulsating flow in the cardio-synchronized copulsation mode over the counterpulsation mode.

What is the central question of this study? Visceral ischaemia is one of the most feared complications during use of an intra-aortic balloon pump. Using an animal model, we measured the flows at the abdominal level directly and examined flow patterns to enable investigation of flow patterns during the use of the intra-aortic balloon pump. What is the main finding and its importance? We show that there is a significant balloon-related reduction in superior mesenteric flow in both early and mid-diastole.A number of previous studies have shown that blood flow in the visceral arteries is altered during intra-aortic balloon pump (IABP) treatment. We used a porcine model to analyse the pattern of blood flow into the visceral arteries during IABP use. For this purpose, we measured the superior mesenteric, right renal and left renal flows before and during IABP support, using surgically placed flowmeters surrounding these visceral arteries. The superior mesenteric flow significantly decreased in early diastole (P 0.001) and in mid-diastole (P = 0.003 versus early diastole), whereas in late diastole it increased again (P 0.001 versus mid-diastole). During systole, the flow was not significantly increased compared with late diastole (P = 0.51), but it was significantly lower than at baseline (both P 0.001). Flows did not differ between right and left kidneys. Perfusion of either kidney did not change significantly in early diastole (P 0.05), whereas it decreased significantly in mid-diastole (P 0.001), rising dramatically in late diastole (P 0.001) and with an additional slight increase in systole (P = 0.054). This study provides important insights into abdominal flows during intra-aortic pump counterpulsation. Furthermore, it supports the need to rethink the balloon design to avoid visceral ischaemia during circulatory assistance.

Background Enhanced external counterpulsation (EECP) is a noninvasive treatment recommended for patients with refractory angina pectoris (RAP), which generally includes 35 one-hour sessions over 7 weeks. No study has described how patients experience the time before, during, and between sessions, as well as the time after EECP treatment. Objective The aim of this study was to describe how patients with RAP experience EECP treatment. Methods Semistructured interviews took place with 15 strategically selected patients (11 men, 58-91 years old) who had finished 7 weeks of EECP at the 2 existing EECP clinics in Sweden. Data were analyzed using inductive qualitative content analysis. Results The results were divided into 4 content areas, each comprising 3 categories: (1) experiences before EECP was initiated comprised uncharted territory, being given a new opportunity, and gain insight; (2) experiences during EECP sessions comprised physical discomfort, need of distraction, and sense of security; (3) experiences between EECP sessions comprised physical changes, socializing, and coordinating everyday life; and (4) experiences after 1 course of EECP treatment comprised improved physical well-being, improved mental well-being, and maintaining angina in check. Conclusions Enhanced external counterpulsation was perceived as an unknown treatment option among these patients with RAP. Nurses should emphasize education before and during treatment based on individualized care needs to improve knowledge and treatment experience, as well as prevent discomfort. There is a great need to increase the awareness of EECP among healthcare professionals because it can improve the life situation for patients with RAP.

Background The NupulseCV intravascular ventricular assist system (iVAS), which consists of a durable pump placed through the subclavian artery, provides extended-duration ambulatory counterpulsation. This study investigated the effect of iVAS on biventricular cardiac function. Methods and Results We reviewed all heart failure patients who received iVAS implantation as a bridge to transplantation or a bridge to candidacy since April 2016 as part of the iVAS first-in-humans and subsequent feasibility study. We compared data of transthoracic echocardiography performed just before implantation (without iVAS support) and again at 30 days or just before explantation (on iVAS support). Eighteen patients (58.8 ± 7.4 years old and 15 male) received iVAS support for 53 ± 43 days. Fourteen patients were bridged to cardiac replacement therapy after 35 ± 19 days and the remaining 4 patients had been supported for 118 ± 41 days. There were no deaths during iVAS support. At 30 days, there was a significant improvement in left ventricular ejection fraction (16.5% ± 11.9% vs 24.4% ± 12.8%; P = .007) and marked reduction in left atrial size (62.7 ± 35.7 mL/m2 vs 33.8 ± 17.2 mL/m2; P Conclusions Improvement in biventricular cardiac function was observed after 30 days of iVAS support. Further studies should examine the use of this technology as a bridge to recovery.

External Counterpulsation (ECP) is one of the therapeutic options in patients with refractory angina inadequately controlled by medical, interventional, or surgical therapy. The 2D Speckle Tracking Echocardiography (2D-STE) method is considered superior in assessing clinical improvement. We would like to evaluate any improvement of myocardial intrinsic function using 2D-STE in patients underwent standard ECP protocol (35 sessions). We conducted a double-blind randomized controlled trial. Patients with refractory angina who could not be revascularized conventionally were randomized into two groups: (1) the ECP group (300 mmHg) and (2) the Sham/control group (75 mmHg). ECP standard therapy was given for 35 sessions (1 h/day/session). The 2D-STE data, including longitudinal strain and post systolic index (PSI) were obtained before and after therapy. 43 subjects were analyzed, with 22 subjects in ECP group and 21 control subjects (Sham group). A homogenous baseline strain was found either globally (12.42 ± 4.55 vs 12.00 ± 4.92 [− %]; P = 0.774) or segmentally/regionally (12.63 (0.01–25.16) vs 12.43 (0.01–27.20) [− %]; P = 0.570). There was no statistically significant improvement between groups in the left ventricle longitudinal strain globally (P = 0.535) and segmentally/regionally (P = 0.434). PSI parameters showed improvement in the ECP group (P = 0.049), and segments with PSI ≥ 20% seemed to improve longitudinal strains in the ECP group after therapy (P = 0.042). In conclusion, 35 ECP therapy sessions did not improve either global or segmental/regional left ventricular mechanical function in patients with refractory angina. However, the mechanical function of myocardial segments with PSS tends to improve after ECP therapy.

Resistance to antiplatelet therapy, especially aspirin or clopidogrel, triggers other therapies for patients with coronary heart disease (CHD). Enhanced external counterpulsation (EECP) is a noninvasive, pneumatic technique that provides beneficial effects for patients with CHD. However, the physiological effects of EECP have not been fully studied, and the role of EECP on platelet function remains poorly understood. A total of 168 patients with CHD were finally selected from the Second Xiangya Hospital and randomly assigned to either a control group or EECP group. The control group accepted only standard medical treatment, while the EECP group accepted standard medical treatment and EECP treatment. Blood samples were collected from patients at baseline and after EECP, and platelet aggregation was assessed. Changes in platelet aggregation were compared before and after treatment. There was no difference in the basal levels of arachidonic acid (AA) induced platelet maximum aggregation ratio (MAR) between the two groups. The AA-induced platelet MAR was significantly decreased after EECP therapy. The logistic analysis showed that low HDL-C was not favorable for the decrease in platelet aggregation. EECP therapy is favorable for lowering platelet aggregation in patients with CHD, especially the AA-induced platelet aggregation ratio.

Introduction: This study aimed to test a computer-driven cardiovascular model for the evaluation of the visceral flow during intra-aortic balloon pump (IABP) assistance. Methods: The model includes a systemic and pulmonary circulation as well as a heart contraction model. The straight polyurethane tube aorta had a single visceral while four windkessel components mimicked resistance compliance of the brachiocephalic, renal and sub-mesenteric, pulmonary, and systemic circulation. Twelve flow probes were placed in the circuit to measure pressures and flows with the IABP on and off. Results: With the balloon off, the meantime to reach the steady state was 48 ± 16 s; with the balloon on, this figure was 178 ± 20 s. The stability of pressure and flow signals was obtained after 72 ± 11 min. The number of cycles of stability of the system was 93 [86–103]. Measurements were reliable either with samples of 10 or 20 beats. Bland Altman method demonstrated the reliability of measurements. Finally, all measurements were comparable to published in vivo data. Conclusion: The presented mock circulation was reliable and gave values with high accuracy both at baseline and during mechanical assistance. This system allows evaluation of the mesenteric flow during IABP, under different clinical/hemodynamic conditions. Nonetheless, its translational potential needs to be further evaluated

Background and aims External counter-pulsation (ECP) generates sheer stress thereby improving endothelial function and anginal symptoms in coronary artery disease. Endothelial dysfunction is also involved in the pathogenesis of T2DM. The aim of this pilot study was to investigate the use of ECP at different doses in improving endothelial function and glycaemic markers in T2DM. Methods This prospective study involved 46 subjects with T2DM randomly assigned to receive 35 sessions of ECP at different regimens (0.5 h versus 1 h) and duration (7 versus 12 weeks). Endothelial function was evaluated by reactive hyperaemia index (RHI) via peripheral arterial tonometry at the start, midpoint and end of study. Other secondary outcomes included fasting glucose, HOMA-IR, HbA1c, blood pressure, lipid profile, weight and vibration sense. Results There was no change in RHI across all 3 regimens of ECP individually or collectively at the end of the study (ΔRHI +0.01%, p = 0.458). Glycaemic markers also remained unchanged at endpoint. Subgroup analysis showed an improvement in RHI (ΔRHI +20.6%, p = 0.0178) in subjects with more severe endothelial dysfunction at baseline. Conclusion ECP did not show a beneficial effect on endothelial function or glycemic control in this South-East Asian population with T2DM at any of the three regimens. This may partly be explained by less severe endothelial dysfunction and less insulin resistance in our population at baseline.

Enhanced External Counterpulsation (EECP) is a non-invasive FDA approved therapy for patients with refractory angina pectoris. The EECP mechanism of action is similar to that of an intra-aortic balloon pump (IABP) by administering a vigorous pressure pulse via external blood pressure cuffs during the diastole. The benefit of EECP includes improvement in angina severity, angina stability, maximal walking capacity and generalized improvement in overall health. Seatle Angina Questionnaire (SAQ) is a valid, reliable and sensitive measure of health-related quality of life. It is also a sensitive and reproducible evaluation tool to measure the response to an intervention. We did a pre-test post-test designed prospective study to evaluate the effect of EECP on the quality of life in patients with CAD. There was a significant difference between SAQ-7 health-related quality of life between the pre-EECP and post-EECP groups (P value=

Background: C-Pulse is a new, nonblood contacting device based on the concept of counter-pulsation that is designed for long-term implantation. However, there is a lack of comprehensive investigation of the pressure and velocity fields under the action of C-Pulse. Aim: In this paper, we aim to conduct a numerical simulation of the underlying mechanism of the device in order to analyze its performance and related undesirable issues. Materials & methods: A 3D finite element model is utilized to simulate the mechanism of the blood pumping. Results & conclusion: The simulation well reproduced the essential characteristics of the C-Pulse. Preliminary results were in a reasonable range while a couple of irregular flow patterns were identified.

Background: The NuPulseCV intravascular ventricular assist system (iVAS) provides extended duration ambulatory counterpulsation via a durable pump placed through the distal subclavian artery. Methods: We performed a prospective, single-arm, multicenter, US Food and Drug Administration-approved feasibility trial of iVAS therapy as a bridge to transplant or decision following the FIH (First-In-Human) trial. Results: Forty-seven patients were enrolled, and 45 patients (median 61 years old, 37 males, and 30 listed on United Network of Organ Sharing) received iVAS support for median 44 (25–87) days. There were no intraoperative complications. Success was defined as survival or transplant on iVAS therapy free from disabling stroke. Outcome success at 30 days (the primary end point of this study) and at 6 months was 89% and 80%, respectively. During 6 months of iVAS support, 2 patients died and 2 patients experienced disabling neurological dysfunction. Six-minute walk distance, 2-minute step test, and Kansas City Cardiomyopathy Questionnaire score improved during 4-week iVAS support. Conclusions: This feasibility trial demonstrated promising short-term outcomes of iVAS therapy with improved functional capacity and quality of life during the therapy. Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT02645539.

Conventional long-term ventricular assist devices continue to be extremely problematic due to infections caused by percutaneous drivelines and thrombotic events associated with the use of blood-contacting surfaces. Here we describe a muscle-powered cardiac assist device that avoids both these problems by using an internal muscle energy converter to drive a non-blood-contacting extra-aortic balloon pump. The technology was developed previously in this lab and operates by converting the contractile energy of the latissimus dorsi muscle into hydraulic power that can be used, in principle, to drive any blood pump amenable to pulsatile actuation. The two main advantages of this implantable power source are that it 1) significantly reduces infection risk by avoiding a constant skin wound, and 2) improves patient quality-of-life by eliminating all external hardware components. The counterpulsatile balloon pumps, which compress the external surface of the ascending aorta during the diastolic phase of the cardiac cycle, offer another critical advantage in the setting of long-term circulatory support in that they increase cardiac output and improve coronary perfusion without touching the blood. The goal of this work is to combine these two technologies into a single circulatory support system that eliminates driveline complications and avoids surface- mediated thromboembolic events, thereby providing a safe, tether-free means to support the failing heart over extended - or even indefinite - periods of time.

Background To explore the effects of enhanced external counterpulsation (EECP) and its underlying influencing factors in nonarteritic anterior ischemic optic neuropathy (NAION) patients. Methods Patients at Zhongshan Ophthalmic Center with recent-onset ( Results In total, 61 patients (76 eyes) were included. Twenty-nine patients (37 eyes) underwent EECP treatment, while 32 patients (39 eyes) were included in the control group. Mean time from NAION onset to EECP initiation was 27.59 ± 16.70 days. In the EECP group, the mean EECP duration was 31.57 ± 18.45 days. EECP was well tolerated by all patients. However, there was no significant difference in visual function between the EECP and control groups. Furthermore, there was no evidence of the effectiveness of EECP in the subgroup analysis of patients with different systemic health conditions. Among the 42 patients with monocular NAION, the sequential attack rate was comparable between the EECP (27.78%) and control (25.00%) groups. Conclusion This study is the first nonrandomized controlled study to evaluate the effectiveness of EECP in NAION patients. Unfortunately, we failed to demonstrate the effectiveness of EECP in NAION at the 6-month follow-up. Any further application of EECP in NAION patients should be cautious.

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.

Contrast-induced acute kidney injury (CI-AKI) is a common complication after exposure to contrast media. Renal ischaemia occurs in the initial stage of CI-AKI, however, there are very few effective measures to improve renal perfusion.A total of 114 patients with an estimated glomerular filtration rate (eGFR) of 60-89 ml/min/1.73mThe primary outcome was observed in 26 patients (6 EECP and 20 control; 11% vs. 35%; P = 0.002). CI-AKI occurred in four patients (0 EECP and 4 control; 0% vs. 7%; P = 0.042). The clearance rate of iopromide in the initial 3 h was significantly different between EECP and control group (59.92 ± 8.84 vs 46.80 ± 9.26 ml/min/1.73 mThis study demonstrates that EECP increases the contrast clearance and may have an effect in reducing the risk of CI-AKI. The study has been registered in Chinese Clinical Trial Registry (ChiCTR 2,000,039,190).

We report two male patients aged 18 and 19 years, respectively, undergoing total pericardiectomy for chronic calcific constrictive pericarditis who developed systemic ventricular failure unresponsive to medical management following surgery. The failing circulation was successfully reestablished using intra-aortic balloon counterpulsation. Aortic counterpulsation facilitates recovery of ventricular function and appears to be a reasonable alternative in select instances of refractory cardiac failure following pericardiectomy.

Traditional clinical mode of enhanced external counterpulsation is not targeted for different diseases. Specialized strategies in the treatment of enhanced external counterpulsation for coronary heart disease and cerebral ischemic stroke are supposed to be distinguished. The goal of treatment for coronary heart disease is diastolic blood pressure/systolic blood pressure = Q ≥ 1.2 after counterpulsation, while the goal of treatment for cerebral ischemic stroke is the improvement of mean arterial pressure. A computational lumped parameter model was established for the simulation of hemodynamic effect of enhanced external counterpulsation on two diseases. Vessel collapse was considered during the simulation of counterpulsation. Based on different pressurized and decompressed rate, pressurized moment, pressure duration, and pressure amplitude, different counterpulsation modes were applied to the model and the immediate hemodynamic effects were compared. Results showed that the pressure duration and pressure amplitude had most influence on two diseases. For cerebral ischemic stroke, the longer pressure duration and the higher pressure amplitude of thighs, the higher mean arterial pressure; while for coronary heart disease, the value of Q was highest when the pressure end moment was 0.6 s during a 0.88-s cardiac cycle, and Q had a linear increase in the pressure amplitude of buttocks, but little change with the increase of calves and thighs pressure amplitude. For patients with coronary heart disease, the pressure duration was not supposed to be too long to avoid the increase of systolic blood pressure, and the improvement of pressure amplitude of buttocks could promise a positive treatment effect for coronary heart disease. While for patients with cerebral ischemic stroke, both the long pressure duration of each part and the high pressure amplitude of thighs could result in the systolic blood pressure and diastolic blood pressure have a certain increase, thus promoting the maximum mean arterial pressure and a best treatment. Graphical abstract The specialized treatment strategies of EECP for cardiovascular and cerebrovascular disease.

Angina persists for many patients despite modern medical therapy and/or revascularization, and this is referred to as refractory angina. All patients with refractory angina must be treated with aggressive risk factor modification plus optimized medical management. β-Blockers and nitrates are usually first-line agents; however most patients require multiple medications for refractory symptom control. Novel agents, such as ranolazine and ivabradine, as well as non-pharmacologic therapies, such as enhanced external counterpulsation and cardiac rehabilitation, may provide relief or reduction of angina. Other standard treatments such as antiplatelet therapy, lipid reduction therapy, blood pressure control, diabetes control, smoking cessation, and wei1ght control should be part of the management of refractory angina as well.

Background The utility of intra-aortic balloon counterpulsation pumps (IABPs) in low cardiac output states is unknown and no studies have explored the impact of IABP therapy on ventricular workload in patients with advanced heart failure (HF). For these reasons, we explored the acute hemodynamic effects of IABP therapy in patients with advanced HF. Methods We prospectively studied 10 consecutive patients with stage D HF referred for IABP placement before left ventricular assist device (LVAD) surgery and compared with 5 control patients with preserved left ventricular (LV) ejection fraction (EF) who did not receive IABP therapy. Hemodynamics were recorded using LV conductance and pulmonary artery catheters. Cardiac index (CI)-responder and CI-nonresponder status was assigned a priori as being “equal to or above” or below the median of the IABP effect on CI, respectively, within 24 hours after IABP activation. Results Compared with controls, patients with advanced HF had lower LVEF, lower LV end-systolic pressure, lower LV stroke work, and higher LV end-diastolic pressures and volumes before IABP activation. IABP activation reduced LV stroke work primarily by reducing end-systolic pressure. IABP therapy increased CI by a median of 20% as well as increased diastolic pressure time index and the myocardial oxygen supply:demand ratio. Compared with CI-nonresponders, CI-responders had higher systemic vascular resistance, lower right heart filling pressures, and a trend toward lower left heart filling pressures with improved indices of right heart function. Compared with CI-nonresponders, the diastolic pressure time index was increased among CI-responders. Conclusions IABP therapy may be effective at reducing LV stroke work, increasing CI, and favorably altering the myocardial oxygen supply:demand ratio in patients with advanced HF, especially among patients with low right heart filling pressures and high systemic vascular resistance.

External counterpulsation (ECP) is a noninvasive method used to augment cerebral perfusion in ischemic stroke. However, the response of beat-to-beat heart rate variability (HRV) in patients with ischemic stroke during ECP remains unknown.Forty-eight patients with unilateral ischemic stroke at the subacute stage and 14 healthy controls were recruited. Beat-to-beat heart rate before, during, and after ECP was monitored. The frequency components of HRV were calculated using power spectral analysis. Very low frequency (VLF;.04 Hz), low frequency (LF; .04-.15 Hz), high frequency (HF; .15-.40 Hz), total power spectral density (TP;.40 Hz), and LF/HF ratio were calculated.In stroke patients, although there were no statistical differences in all of the HRV components, the HRV at VLF showed a trend of increase during ECP compared with baseline in the left-sided stroke patients (P = .083). After ECP, the HRV at LF and TP remained higher than baseline in the right-sided stroke patients (LF, 209.4 versus 117.9, P = .050; TP, 1275.6 versus 390.2, P = .017, respectively). Besides, the HRV at TP also increased after ECP compared with baseline in the left-sided stroke patients (563.0 versus 298.3, P = .029).Irrespective of the side of the ischemia, patients showed an increased beat-to-beat HRV after ECP. Additionally, sympathetic and parasympathetic cardiac modulations were increased after ECP in patients after right-sided subacute stroke.

Mechanical circulatory support devices (MCSDs) have gained widespread clinical acceptance as an effective heart failure (HF) therapy. The concept of harnessing the kinetic energy (KE) available in the forward aortic flow (AOF) is proposed as a novel control strategy to further increase the cardiac output (CO) provided by MCSDs. A complete mathematical development of the proposed theory and its application to an example MCSDs (two-segment extra-aortic cuff) are presented. To achieve improved device performance and physiologic benefit, the example MCSD timing is regulated to maximize the forward AOF KE and minimize retrograde flow. The proof-of-concept was tested to provide support with and without KE control in a computational HF model over a wide range of HF test conditions. The simulation predicted increased stroke volume (SV) by 20% (9 mL), CO by 23% (0.50 L/min), left ventricle ejection fraction (LVEF) by 23%, and diastolic coronary artery flow (CAF) by 55% (3 mL) in severe HF at a heart rate (HR) of 60 beats per minute (BPM) during counterpulsation (CP) support with KE control. The proposed KE control concept may improve performance of other MCSDs to further enhance their potential clinical benefits, which warrants further investigation. The next step is to investigate various assist technologies and determine where this concept is best applied. Then bench-test the combination of kinetic energy optimization and its associated technology choice and finally test the combination in animals.

Improving tissue perfusion in peri-infarct cortex could enhance neuroplasticity and improve functional recovery after stroke.1 Treatments that enhance corticomotor function may benefit motor recovery. However, the effects of cerebral blood flow augmentation on corticomotor excitability have not been explored in humans. External counterpulsation (ECP) is a non-invasive method to improve perfusion of vital organs.2 It operates by applying ECG-triggered pressure to the lower extremities during diastole by means of air-filled cuffs. The diastolic augmentation of blood flow and the reduction of systolic afterload increases blood flow to the heart, brain and kidneys. In patients who had ischaemic stroke, ECP enhances cerebral blood flow velocities and can be associated with improvement in the neurological outcome.3 ECP may improve cerebral perfusion and collateral blood supply in ischaemic stroke by augmenting blood pressure and cerebral blood flow velocity.4 The effects of ECP on corticomotor excitability are unknown. We aimed to explore the effects of ECP on corticomotor excitability and upper limb motor recovery. We hypothesised that enhancing cerebral blood flow with ECP will facilitate ipsilesional corticomotor excitability and improve upper limb performance at the subacute stage of recovery after ischaemic stroke. First-ever ischaemic stroke patients with upper limb impairment with onset between 4 days and 21 days were enrolled. Exclusion criteria were cardioembolic stroke, sustained hypertension (systolic >180 mm Hg or diastolic >100 mm Hg), bleeding diathesis, vascular malformation, epilepsy, pregnancy, metal or electronic implants, severe head injury, severe systemic diseases and malignancy. Patients were randomised (1:1) to either real or sham ECP. ECP was performed using an ECP system (MC2, Vamed Medical Instrument Company, Foshan, China). Both groups completed 10 sessions of ECP for 1 hour per day, delivered over …

To study the impact of external counterpulsation (ECP) on endothelial function and microcirculation in patients after myocardial revascularization (stenting and coronary artery bypass grafting) for functional class (FC) II-III chronic heart failure (CHF).Sixty patients aged 50 to 75 years after myocardial revascularization for FC II-III CHF were examined. All the patients received one-hour ECP sessions 5 times per week. The treatment cycle consisted of 35 sessions. To evaluate the microcirculatory bed, capillary blood flow was studied by laser Doppler flowmetry.The cycle of ECP in patients with FC II-III CHF after myocardial revascularization had a corrective effect on the microhemodynamic system. Microcirculatory changes were due to the normalized myogenic and neurogenic tone of arterioles and to increased oscillations in the endothelial range. The pronounced beneficial effect of ECP on the cardiovascular system in the examined patients was confirmed by a significant increase in exercise tolerance and by a statistically significant improvement in the results of 6-minute walk test. There was a decrease in FC heart failure.ECP is an effective, non-invasive treatment in patients with heart failure.Изучить влияние наружной контрпульсации (НКП) на эндотелиальную функцию и состояние микроциркуляции у пациентов после реваскуляризации миокарда (стентирование и коронарное шунтирование) с хронической сердечной недостаточностью (ХСН) II-III функционального класса (ФК).Обследованы 60 больных после реваскуляризации миокарда с ХСН II-III ФК в возрасте от 50 до 75 лет. Все пациенты получали одночасовые процедуры НКП 5 раз в неделю. Курсовое лечение включало 35 процедур. Для оценки состояния микроциркуляторного русла проводили изучение капиллярного кровотока методом лазерной допплеровской флоуметрии.Курсовое применение НКП у пациентов с ХСН II-III ФК после реваскуляризации миокарда оказывало корригирующее действие на систему микрогемодинамики. Изменения микроциркуляции были обусловлены нормализацией миогенного и нейрогенного тонуса артериол, усилением осцилляций эндотелиального диапазона. Выраженное благоприятное воздействие НКП на сердечно-сосудистую систему у обследуемых пациентов подтверждалось достоверным повышением толерантности к физической нагрузке, статистически значимым улучшением результатов теста 6-минутной ходьбы. Отмечено уменьшение ФК сердечной недостаточности.НКП является эффективным, неинвазивным методом лечения пациентов с сердечной недостаточностью.

Cardiovascular diseases occupy a leading place in the structure of morbidity in Russia and other developed countries of the world.To study the efficiency of using enhanced external counterpulsation in the comprehensive rehabilitation treatment of patients with stages I-IIB obliterating atherosclerosis of the lower extremities (OALE).A total of 68 patients aged 50 to 78 years with stages I-IIb oale in the presence of clinical symptomatology of arterial insufficiency were examined and treated. According to the method of treatment, the patients were divided into two groups: 1) 32 people received a standard drug therapy (a control group). 2) 36 patients had an enhanced external counterpulsation therapy cycle during the standard therapy (a study group). The frequency of characteristic complaints, pain-free walking distance, peripheral hemodynamics, and the ankle-brachial index (abi) were assessed.Posttreatment leg pain on walking persisted in 11 (30.6%) and 25 (78.1%) patients in the study group and in the control one, respectively; there were leg cramps in 9 (25.0%) and 14 (43.8%) people and cold feet in 5 (13.9%) and 25 (78.1%) patients, respectively (p0.05). In the study group, the considerable increase in pain-free walking distance as compared to baseline values averaged 250±31.2 m (p0.05), while that in the control group was only 64.5±25.1 m (p0.05). The posttreatment increase in the leg and foot rheographic indices averaged 23.9 and 23.2%, respectively, in the study group and 11.9 and 12.3%, respectively, in the control group. The increases in abi in the anterior and posterior tibial arteries were 31.4 and 35.2%, respectively, in the study group (p0.05), and 16.0 and 13.0%, respectively, in the control group (p0.05).The findings suggest that the use of enhanced external counterpulsation in the combination therapy of patients with stages I-IIb oale is a clinically effective and safe treatment.Обоснование. Сердечно-сосудистые патологии занимают ведущее место в структуре заболеваемости населения России и других развитых стран мира. Цель исследования - изучить эффективность применения метода усиленной наружной контрпульсации в комплексном восстановительном лечении пациентов с облитерирующим атеросклерозом сосудов нижних конечностей (ОАСНК) I-IIБ стадии. Материал и методы. Проведено обследование и лечение 68 пациентов в возрасте от 50 до 78 лет с ОАСНК I-IIБ стадией с наличием клинической симптоматики артериальной недостаточности. В зависимости от метода лечения все пациенты были распределены на две группы: 1-я (контрольная) группа (n=32) получала стандартную медикаментозную терапию; 2-я (основная) группа (n=36) на фоне стандартной терапии получала курс усиленной наружной контрпульсации. Оценивали частоту характерных жалоб, дистанцию безболевой ходьбы, состояние периферической гемодинамики, лодыжечно-плечевой индекс (ЛПИ). Результаты. Боли в ногах при ходьбе после лечения сохранялись у 11 (30,6%) пациентов в основной группе и 25 (78,1%) больных в группе контроля, судороги в икроножных мышцах - у 9 (25,0%) и 14 (43,8%) человек соответственно и зябкость стоп - у 5 (13,9%) и 25 (78,1%) пациентов соответственно (p0,05). Существенное увеличение дистанции безболевой ходьбы по сравнению с исходными показателями в основной группе составило в среднем 250±31,2 м (p0,05), в то время как в контрольной группе прирост дистанции составил лишь 64,5±25,1 м (p0,05). После лечения в основной группе повышение реографического индекса голеней и стоп составило в среднем 23,9 и 23,2% соответственно, в контрольной группе - 11,9 и 12,3% соответственно. Увеличение ЛПИ на передней и задней большеберцовых артериях в основной группе составило 31,4 и 35,2% соответственно (p0,05), в контрольной группе - 16,0 и 13,0% соответственно (p0,05). Заключение. Полученные данные свидетельствуют о том, что применение усиленной наружной контрпульсации в комп-лексной терапии пациентов с ОАСНК I-IIБ стадии является клинически эффективным и безопасным методом лечения.

Purpose Enhanced external counterpulsation (EECP) is popular in China for the treatment of coronary heart diseases, but it may be an effective treatment for other populations. This study aimed to explore the effect of EECP on exercise endurance of healthy people and chronic obstructive pulmonary disease (COPD) patients and provide intervention measures to improve their physical condition. Patients and methods Patients were enrolled in this pilot randomized controlled trial at Jiangbin Hospital, China, between March 1st and May 30th, 2018. They were randomly divided into the EECP and non-EECP groups. According to their maximal oxygen uptake, the volunteers were also sub-grouped into the normal, low exercise endurance, and COPD subgroups. Differences in exercise endurance were evaluated between the EECP and non-EECP groups before and after treatment. Cardiopulmonary exercise testng included anaerobic threshold oxygen uptake (AT-VO2Kg), maximum oxygen uptake (Max-VO2Kg), anaerobic threshold pulse (AT-O2puls), anaerobic threshold metabolic equivalent (AT-Mets), and maximum metabolic equivalent (Max-Mets). Results 72 volunteers were enrolled. The EECP and non-EECP groups were similar in terms of age, sex, body mass index, blood pressure, heart rate, breathing frequency, AT-VO2Kg, Max-VO2Kg, AT-O2puls, AT-Mets, and Max-Mets (P > 0.05) before treatment. EECP significantly improved AT-VO2Kg, Max-VO2Kg, AT-O2puls, AT-Mets, and Max-Mets compared with the non-EECP group (P

Refractory angina (RA), which is characterized by tissue ischemia along with neurological, mitochondrial, and psychogenic dysfunction, is becoming a major cause of morbidity in patients with advanced coronary artery disease. In this review, we discuss in detail the invasive mechanical non-cell therapy–based options, the evidence behind these therapies, and future trends. There is extensive ongoing research in the areas of spinal-cord stimulation, transmyocardial laser revascularization, sympathectomy, angiogenesis, and other non-cell-based therapies to explore the best therapy for refractory angina. There is conflicting data in the literature suggesting subjective improvement in angina, but very few studies boast improvement in core objective parameters such as myocardial blood flow, survival, or rehospitalizations. Patients with refractory angina are a complex group of patients that need novel approaches to help alleviate their symptoms and reduce mortality. A carefully selected sequence of therapies may provide the best results in this patient population.

Despite optimal combination of guideline-directed anti-ischemic therapies and myocardial revascularization, a substantial proportion of patients with stable coronary artery disease continues to experience disabling symptoms and is often referred as "no-option." The appraisal of the pathways linking ischemia to symptom perception indicates a complex model of heart-brain interactions in the generation of the subjective anginal experience and inspired novel approaches that may be clinically effective in alleviating the angina burden of this population. Conversely, the prevailing ischemia-centered view of angina, with the focus on traditional myocardial revascularization as the sole option to address ischemia on top of medical therapy, hinders the experimental characterization and broad-scale clinical implementation of strongly needed therapeutic options. The interventionist, often the first physician to establish the diagnosis of refractory angina pectoris (RAP) following coronary angiography, should be aware of the numerous emerging technologies with the potential to improve quality of life in the growing population of RAP patients. This review describes the current landscape and the future perspectives on nonpharmacological treatment technologies for patients with RAP, with a view on the underlying physiopathological rationale and current clinical evidence.

Background Enhanced external counterpulsation (EECP) is an effective method for treating patients with cerebral ischemic stroke, while hemodynamics is the major contributing factor in the treatment of EECP. Different counterpulsation modes have the potential to lead to different acute and long-term hemodynamic changes, resulting in different treatment effects. However, various questions about appropriate counterpulsation modes for optimizing hemodynamic effects remain unanswered in clinical treatment. Methods A zero-dimensional/three-dimensional (0D/3D) geometric multiscale model of the cerebral artery was established to obtain acute hemodynamic indicators, including mean arterial pressure (MAP) and cerebral blood flow (CBF), as well as localized hemodynamic details for the cerebral artery, which includes wall shear stress (WSS) and oscillatory shear index (OSI). Counterpulsation was achieved by applying pressure on calf, thigh and buttock modules in the 0D model. Different counterpulsation modes including various pressure amplitudes and pressurization durations were applied to investigate hemodynamic responses, which impact acute and long-term treatment effects. Both vascular collapse and cerebral autoregulation were considered during counterpulsation. Results Variations of pressure amplitude and pressurization duration have different impacts on hemodynamic effects during EECP treatment. There were small differences in the hemodynamics when similar or different pressure amplitudes were applied to calves, thighs and buttocks. When increasing pressure amplitude was applied to the three body parts, MAP and CBF improved slightly. When pressure amplitude exceeded 200 mmHg, hemodynamic indicators almost never changed, demonstrating consistency with clinical data. However, hemodynamic indicators improved significantly with increasing pressurization duration. For pressurization durations of 0.5, 0.6 and 0.7 s, percentage increases for MAP during counterpulsation were 1.5%, 23.5% and 39.0%, for CBF were 1.2%, 23.4% and 41.6% and for time-averaged WSS were 0.2%, 43.5% and 85.0%, respectively. Conclusions When EECP was applied to patients with cerebral ischemic stroke, pressure amplitude applied to the three parts may remain the same. Patients may not gain much more benefit from EECP treatment by excessively increasing pressure amplitude above 200 mmHg. However, during clinical procedures, pressurization duration could be increased to 0.7 s during the cardiac circle to optimize the hemodynamics for possible superior treatment outcomes.

Enhanced external counterpulsation (EECP) is a noninvasive treatment method for coronary artery atherosclerosis that acts on the vascular endothelial cells. The intracoronary hemodynamic parameters that influence long-term treatment effect are the fundamental factors for the inhibition of intimal hyperplasia, which cannot be measured in real time. In order to optimize the long-term treatment effect of coronary heart disease, it is necessary to establish a method for quantified calculation of intracoronary hemodynamic parameters during counterpulsation to research the long-term hemodynamic mechanism of EECP. A geometric multiscale model coupled by the zero-dimensional (0D) lumped parameter model and the three-dimensional (3D) model of narrow coronary artery was established for the simulation of intracoronary hemodynamic environment. The 3D model was used to calculate the hemodynamic parameters such as wall shear stress (WSS) and oscillatory shear index (OSI), while the 0D model was used to simulate the blood circulatory system. Sequential pressure was applied to calves, thighs, and buttocks module in 0D model with the consideration of vessel collapse. Hemodynamic performance was compared with clinical reports to verify the effectiveness of the method. There were significant increases of the diastolic blood pressure (DBP), coronary flow, and the area-averaged WSS during application of EECP, while OSI behind stenosis has some decrease. The waveforms of coronary flow has good similarity with the clinical measured waveforms, and the differences between calculated mean arterial pressures (MAPs) and clinical measurements were within 1%. The fundamental factor in the cure of coronary heart disease by EECP is the improvement of WSS and the decrease of OSI. Comparing with the clinical reports, the immediate hemodynamic changes demonstrate the effectiveness of model. Intracoronary hemodynamic parameters during EECP could be acquired and the method could be used to simulate the long-term treatment effect of EECP. Graphical abstract.

Heart failure (HF) affects millions of Americans and causes financial burdens because of the need for rehospitalization. For this reason, health care systems and patients alike are seeking methods to decrease readmissions. We assessed the potential for reducing readmissions of patients with postacute care HF through an educational program combined with enhanced external counterpulsation (EECP). We examined 99 patients with HF who were referred to EECP centers and received heart failure education and EECP treatment within 90 days of hospital discharge from March 2013 to January 2015. We compared observed and predicted 90-day readmission rates and examined results of 6-minute walk tests, Duke Activity Status Index, New York Heart Association classification, and Canadian Cardiovascular Society classification before and after EECP. Patients were treated with EECP at a median augmentation pressure of 280 mm Hg (quartile 1 = 240, quartile 3 = 280), achieved as early as the first treatment. Augmentation ratios varied from 0.4 to 1.9, with a median of 1.0 (quartile 1 = 0.8, quartile 3 = 1.2). Only 6 patients (6.1%) had unplanned readmissions compared to the predicted 34%, p