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In this study, we aimed to assess the effects of enhanced external counterpulsation (EECP) and individual shear rate therapy (ISRT) on peripheral artery function in patients with lower extremity atherosclerotic disease (LEAD). We randomly assigned 45 LEAD patients to receive 35 sessions of 45 min of EECP ( n  = 15), ISRT ( n  = 15), or sham-control ( n  = 15). Flow-mediated dilation in the brachial artery (brachial-FMD); 6-min walk distance; blood flow in the popliteal, posterior tibial, anterior tibial, and dorsalis pedis arteries; and plasma levels were measured before and after the 7 weeks treatment. 36-item Short Form Health Survey [SF-36] was analyzed before, after 7 weeks, and 3-month follow-ups. EECP treatment significantly improved brachial-FMD and quality of life, increased walking distance, and increased blood flow and the diameters of the popliteal artery and posterior tibial artery (all P  < 0.01). Conversely, ISRT markedly increased blood flow in the anterior tibial artery ( P  < 0.05). EECP and ISRT decreased the endothelin-1 and asymmetrical dimethylarginine levels in patients with LEAD (both P  < 0.01). Additionally, sVCAM-1 was significantly reduced after EECP intervention ( P  = 0.004). Our findings demonstrate that EECP and ISRT have beneficial effects on walking distance, quality of life, flow-mediated dilation, endothelial-derived vasoactive agents, and inflammatory and oxidative stress in LEAD patients. Date of registration: 2021-06-21. Trial registration: ChiCTR2100048086.

Intradialytic cardiac output (CO) decline normally occurs during hemodialysis (HD) and results in short-term intradialytic hypotension to longer-term increased cardiovascular morbidity and mortality in chronic HD patients. Enhanced external counter pulsation (EECP) is a novel non-invasive device that has been demonstrated to improve coronary blood flow and maintain systemic hemodynamics in patients without kidney dysfunction. This study is the first to explore the efficacy and safety of EECP application during HD on intradialytic changes of CO and other hemodynamic parameters. Stable chronic HD patients without recent cardiovascular events were randomly allocated to the EECP group (n = 7) receiving a single session of 60-min EECP therapy at the early period of 4-h online hemodiafiltration (HDF), and the control group (n = 7) obtaining standard 4-h online HDF without EECP. Interval measurements of intradialytic CO by Transonic HD03 device, intradialytic central aortic blood pressure (BP) by AtCor Medical SphygmoCor-XCEL device, and heart rate (HR) in the mid-week HD sessions were conducted. Changes in these parameters were compared with a linear mixed model. CO of the patients in the EECP group was maintained throughout the HDF session compared to a significant CO decline of 2.4 L/min after 4-h HDF in the control group (p-value 0.007). Cardiac index (CI) also changed in the same direction as CO. Central systolic BP, central diastolic BP, central mean arterial pressure, and HR were indifferent between the two groups. In 9 patients continuing the study in the subsequent 36 HDF sessions, there was a trend to prevent the increase in high-sensitivity cardiac troponin I by long-term EECP treatment. No intolerable adverse events related to EECP were reported. EECP application during online HDF could maintain CO, CI, and might reduce the risk of HD-related myocardial ischemia through various proposed mechanisms, including promoting coronary perfusion. However, larger studies on other cardiovascular outcomes are warranted.

Objective To observe, compare and explore the effect of enhanced extracorporeal counterpulsation (EECP) treatment on cardiac rehabilitation in patients with acute myocardial infarction (AMI) after undergoing percutaneous coronary intervention (PCI) using a drug-coated balloon (DCB). Methods This study was a prospective randomised controlled trial of 60 patients with AMI after undergoing PCI using a DCB. Using a random number table method, the patients were randomly divided into control and rehabilitation groups, with 30 patients in each. The follow-up period was 6 months. Patients in the control group received conventional drug and exercise rehabilitation after undergoing DCB-based PCI; those in the rehabilitation group were also given an EECP-based rehabilitation regimen after 7 days of medication and exercise rehabilitation. The effects of EECP on the rehabilitation of patients with AMI after undergoing DCB-based PCI were evaluated by observing changes in cardiac function before and after treatment in the two groups of patients, including cardiac output (CO), stroke volume (SV), brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF) and 6-minute walking distance (6MWD). Results After 6 months of treatment, the control versus the rehabilitation groups’ cardiac function results were as follows: CO (5.00 ± 0.67 vs. 4.64 ± 0.58, P  = 0.023), SV (70.53 ± 3.33 vs. 65.57 ± 6.10, P  < 0.001), BNP (157.63 ± 15.37 vs. 219.40 ± 16.73, P  < 0.001), LVEF (65.57 ± 4.33 vs. 60.10 ± 2.92, P  < 0.001) and 6MWD (455.43 ± 39.75 vs. 400.73 ± 36.81, P  < 0.001). The patients in the rehabilitation group showed improved cardiac function compared with the control group, with statistically significant differences. Furthermore, the improvement in the New York Heart Association cardiac function grading ( P  < 0.001) and Canadian Cardiovascular Association angina grading ( P  < 0.001) in the rehabilitation group were significantly improved compared with the gradings of the control group. Conclusion Using EECP treatment significantly improved the cardiac function of patients with AMI after undergoing DCB-based PCI and was beneficial for their cardiac rehabilitation.

IntroductionCoronary microcirculation dysfunction (CMD) is prevalent in patients with coronary artery disease (CAD). Current therapies for CMD are focused on pharmacotherapy, non-pharmacological treatments such as enhanced external counterpulsation (EECP) have shown favourable results in patients with CAD. However, whether EECP can improve CMD remains unknown. This study is designed to evaluate the effectiveness of EECP on CMD in patients with CAD, and to assess the feasibility of conducting a multicentre randomised controlled trial.Methods and analysisThis study is a single-centre, outcome-assessor-blinded, parallel randomised controlled trial. A total of 110 participants with CAD will be included and randomly assigned to either the intervention group (EECP plus optimal medical therapy (OMT)) or the control group (OMT alone). EECP will be administered by operators for 60 min, 5 times per week for 7 weeks (35 times in total). Outcomes include patients’ retention rates, the primary outcome and secondary outcomes. The primary outcome is the change in Myocardial Perfusion Reserve Index with cardiac MRI from baseline to the end of follow-up. The planned study duration is from 2024 to 2026.Ethics and disseminationEthical approval was obtained from the Ethics Committee of the Eighth Affiliated Hospital, Sun Yat-sen University (ID: 2023-045-03). The findings will be disseminated in peer-reviewed publications.Trial registration numberChiCTR2300076231.

Background 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. Methods 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. Results 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. Conclusion EECP therapy is favorable for lowering platelet aggregation in patients with CHD, especially the AA-induced platelet aggregation ratio.

BackgroundThe efficacy of external counterpulsation (ECP) on coronary collateral growth has not been investigated in a randomised controlled study.ObjectiveTo test the hypothesis that ECP augments collateral function during a 1 min coronary balloon occlusion.Patients and methodsTwenty patients with chronic stable coronary artery disease were studied. Before and after 30 h of randomly allocated ECP (20 90 min sessions over 4 weeks at 300 mm Hg inflation pressure) or sham ECP (same setting at 80 mm Hg inflation pressure), the invasive collateral flow index (CFI, no unit) was obtained in 34 vessels without coronary intervention. CFI was determined by the ratio of mean distal coronary occlusive pressure to mean aortic pressure with central venous pressure subtracted from both. Additionally, coronary collateral conductance (occlusive myocardial blood flow per aorto-coronary pressure drop) was determined by myocardial contrast echocardiography, and brachial artery flow-mediated dilatation was obtained.ResultsCFI changed from 0.125 (0.073; interquartile range) at baseline to 0.174 (0.104) at follow-up in the ECP group (p=0.006), and from 0.129 (0.122) to 0.111 (0.125) in the sham ECP group (p=0.14). Baseline to follow-up change of coronary collateral conductance was from 0.365 (0.268) to 0.568 (0.585) ml/min/100 mm Hg in the ECP group (p=0.072), and from 0.229 (0.212) to 0.305 (0.422) ml/min/100 mm Hg in the sham ECP group (p=0.45). There was a correlation between the flow-mediated dilatation change from baseline to follow-up and the corresponding CFI change (r=0.584, p=0.027).ConclusionsECP appears to be effective in promoting coronary collateral growth. The extent of collateral function improvement is related to the amount of improvement in the systemic endothelial function.

Advanced heart failure (HF) patients not meeting criteria for ventricular assist device or heart transplant with life-limiting symptoms are limited to medical and resynchronization therapy. The Sunshine Heart C-Pulse, based on intra-aortic balloon pump physiology, provides implantable, on-demand, extra-aortic counterpulsation, which reduces afterload and improves cardiac perfusion in New York Heart Association Class III and ambulatory Class IV HF. The C-Pulse reduces New York Heart Association Class, improves 6-min walk distances, inotrope requirements and HF symptom questionnaires. Advantages include shorter operative times without cardiopulmonary bypass, no reported strokes or thrombosis and no need for anticoagulation. Driveline exit site infections, inability to provide full circulatory support and poor function with intractable arrhythmias remain concerns. Current randomized controlled studies will evaluate long-term efficacy and safety compared with medical and resynchronization therapy.

Despite advances in care processes to improve reperfusion in patients with acute myocardial infarction (AMI), the short-term and 1-year mortality remains high, in part, because of reperfusion injury, microvascular obstruction, and infarct expansion. Intraaortic balloon counterpulsation (IABC) is an adjunct to revascularization and has reduced microvascular obstruction and infarct size in animal models of AMI. CRISP AMI is a multicenter randomized trial that aims to determine if IABC initiated before percutaneous coronary intervention (PCI) for reperfusion compared with routine PCI in patients with anterior ST-segment elevation AMI reduces infarct size as measured by cardiac magnetic resonance imaging. Patients are randomly assigned to receive IABC initiated before primary PCI and continued for at least 12 hours or routine PCI with standard-of-care medical therapy in both groups. The primary efficacy end point is infarct size measured by cardiac magnetic resonance imaging at 3 to 5 days post-PCI. The secondary clinical end point is the composite of major adverse clinical events including death, reinfarction, and heart failure at 6 months. According to sample size calculation, 300 patients will be randomized at 50 sites across 10 countries. The CRISP AMI study will determine if IABC before reperfusion in patients with anterior AMI reduces infarct size.

Enhanced External Counterpulsation (EECP), as a non-invasive, cost-effective, and efficient adjunctive circulatory technique, has been widely applied in in the cardiovascular field. Numerous studies and clinical observations have confirmed the obvious advantages of EECP in promoting blood flow perfusion to vital organs such as the heart, brain, and kidneys. However, many potential mechanisms of EECP remain insufficiently validated, necessitating researchers to dedicate substantial time and effort to in-depth investigations. In this work, large language models (such as ChatGPT and Ernie Bot) were used to identify top research priorities in five key topics in the field of EECP: mechanisms, device improvements, cardiovascular applications, neurological applications, and other applications. After generating specific research priorities in each domain through language models, a panel of nine experienced EECP experts was invited to independently evaluate and score them based on four parameters: relevance, originality, clarity, and specificity. Notably, high average and median scores for these evaluation parameters were obtained, indicating a strong endorsement from experts in the EECP field. This study preliminarily suggests that large language models like ChatGPT and Ernie Bot could serve as powerful tools for identifying and prioritizing research priorities in the EECP domain.