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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.

Lumped parameter model (LPM) is a common numerical model for hemodynamic simulation of human’s blood circulatory system. The numerical simulation of enhanced external counterpulsation (EECP) is a typical biomechanical simulation process based on the LPM of blood circulatory system. In order to simulate patient-specific hemodynamic effects of EECP and develop best treatment strategy for each individual, this study developed an optimization algorithm to individualize LPM elements. Physiological data from 30 volunteers including approximate aortic pressure, cardiac output, ankle pressure and carotid artery flow were clinically collected as optimization objectives. A closed-loop LPM was established for the simulation of blood circulatory system. Aiming at clinical data, a sensitivity analysis for each element was conducted to identify the significant ones. We improved the traditional simulated annealing algorithm to iteratively optimize the sensitive elements. To verify the accuracy of the patient-specific model, 30 samples of simulated data were compared with clinical measurements. In addition, an EECP experiment was conducted on a volunteer to verify the applicability of the optimized model for the simulation of EECP. For these 30 samples, the optimization results show a slight difference between clinical data and simulated data. The average relative root mean square error is lower than 5%. For the subject of EECP experiment, the relative error of hemodynamic responses during EECP is lower than 10%. This slight error demonstrated a good state of optimization. The optimized modeling algorithm can effectively individualize the LPM for blood circulatory system, which is significant to the numerical simulation of patient-specific hemodynamics.

Background Femoral neck fractures often lead to complications such as delayed union or nonunion due to limited blood supply to the femoral head. Enhanced external counterpulsation (EECP) is a non-invasive method that improves peripheral and tissue perfusion. This study aimed to evaluate whether postoperative EECP could promote fracture healing and improve hip function recovery after cannulated screw fixation for femoral neck fractures. Methods This single-center, prospective, randomized controlled trial included patients with acute femoral neck fractures eligible for cannulated screw fixation. Participants were randomized in a 1:1 ratio into two groups using a computer-generated random sequence. Group assignments were sealed in opaque envelopes to ensure allocation concealment. Baseline characteristics were comparable between groups. Three weeks postoperatively, patients in the EECP group underwent daily 1-hour EECP sessions for 7 consecutive weeks, while the control group received standard care without EECP. Color Doppler ultrasound was used to measure the peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI) of the medial femoral circumflex artery on the ipsilateral fracture side. Fracture union time, as well as the incidences of avascular necrosis of the femoral head (ANFH) and nonunion, were recorded. The Harris Hip Score (HHS) was assessed at 3, 6, and 12 months postoperatively. Results A total of 64 patients completed at least 24 months of follow-up, including 31 in the EECP group and 33 in the control group. After the final EECP session, the EECP group demonstrated significantly higher PSV and EDV values compared to the control group (both p  < 0.0001; 95% CI: -10.55 to -7.42, -3.83 to -3.22, respectively), while RI values were significantly lower ( p  < 0.0001, 95% CI: 0.04 to 0.06). All fractures healed in both groups, but the mean healig time was significantly shorter in the EECP group ( p  < 0.0001, 95% CI: 1.24 to 2.72). There was no significant difference between the two groups in the occurrence rate of ANFH ( p  = 0.615, 95% CI: -3.08 to 0.54). At 3 months postoperatively, there was no significant difference in HHS between the two groups ( p  = 0.165, 95% CI: -3.08 to 0.54). However, at 6 and 12 months, the EECP group showed significantly higher HHS values compared to the control group ( p  < 0.0001, 95% CI: -10.91 to -7.36; p  = 0.0006, 95% CI: -10.81 to -3.12, respectively). Conclusions Enhanced external counterpulsation appears to be a safe and potentially beneficial adjunctive strategy for the management of femoral neck fractures treated with cannulated screw fixation. The application of enhanced external counterpulsation may promote fracture healing and facilitate hip function recovery by improving blood perfusion of the femoral head and the fracture site. Name of trial registry Chinese Clinical Trial Register (ChiCTR); Registration number: ChiCTR2000034312; Date of registration: 01/07/2020.

Enhanced external counterpulsation (EECP) is widely utilized in rehabilitating patients after percutaneous coronary intervention (PCI) and has demonstrated efficacy in promoting cardiovascular function recovery. Although the precise mechanisms of the therapeutic effects remain elusive, it is widely postulated that the improvement of biomechanical environment induced by EECP plays a critical role. This study aimed to unravel the underlying mechanism through a numerical investigation of the in-stent biomechanical environment during EECP using an advanced multi-dimensional 0/1D-3D coupled model. Physiological data, including age, height, coronary angiography images, and blood velocity profiles of five different arteries, were clinically collected from eleven volunteers both at rest and during EECP. These data contributed the development of a patient-specific 0/1D model to predict the coronary volumetric flow and a 3D stented coronary artery model to capture the detailed in-stent biomechanical features. Specifically, an immersed solid method was introduced to address the numerical challenges of generating computational cells for the 3D model. Simulations revealed that EECP significantly improved the biomechanical environment within the stented arteries, as evidenced by increased time-averaged wall shear stress (resting vs. 20 kPa vs. 30 kPa: 1.39 ± 0.4773 Pa vs. 1.82 ± 0.6856 Pa vs. 1.96 ± 0.7592 Pa, p = 0.0009) and reduced relative residence time (resting vs. 20 kPa vs. 30 kPa: 1.06 ± 0.3926 Pa−1 vs. 0.89 ± 0.3519 Pa−1 vs. 0.87 ± 0.3764 Pa−1, p < 0.0001). Correspondingly, low-WSS/high-RRT surfaces were obviously reduced under EECP. These findings provide deeper insights into EECP’s therapeutic mechanisms, thereby offering basis to optimize EECP protocols for enhanced clinical outcomes in post-PCI patients.

Adult stem cell therapy via intramyocardial injection of autologous CD34+ stem cells has been shown to improve exercise capacity and reduce angina frequency and mortality in patients with refractory angina (RA). However, the cost of such therapy is a limitation to its adoption in clinical practice. Our goal was to determine whether the less costly, less invasive, and widely accessible, FDA-approved alternative treatment for RA patients, known as enhanced external counterpulsation (EECP), mobilizes endogenous CD34+ stem cells and whether such mobilization is associated with the clinical benefits seen with intramyocardial injection. We monitored changes in circulating levels of CD34+/CD133+ and CD34+/KDR+ cells in RA patients undergoing EECP therapy and in a comparator cohort of RA patients undergoing an exercise regimen known as cardiac rehabilitation. Changes in exercise capacity in both cohorts were monitored by measuring treadmill times (TT), double product (DP) scores, and Canadian Cardiovascular Society (CCS) angina scores between pre- and post-treatment treadmill stress tests. Circulating levels of CD34+/CD133+ cells increased in patients undergoing EECP and were significant (β = −2.38, p = 0.012) predictors of improved exercise capacity in these patients. CD34+/CD133+ cells isolated from RA patients could differentiate into endothelial cells, and their numbers increased during EECP therapy. Our results support the hypothesis that mobilized CD34+/CD133+ cells repair vascular damage and increase collateral circulation in RA patients. They further support clinical interventions that can mobilize adult CD34+ stem cells as therapy for patients with RA and other vascular diseases.

Enhanced external counterpulsation (EECP) is a treatment and rehabilitation approach for ischemic diseases, including coronary artery disease. Its therapeutic benefits are primarily attributed to the improved blood circulation achieved through sequential mechanical compression of the lower extremities. However, despite the crucial role that hemodynamic effects in the lower extremity arteries play in determining the effectiveness of EECP treatment, most studies have focused on the diastole phase and ignored the systolic phase. In the present study, a novel siphon model (SM) was developed to investigate the interdependence of several hemodynamic parameters, including pulse wave velocity, femoral flow rate, the operation pressure of cuffs, and the mean blood flow changes in the femoral artery throughout EECP therapy. To verify the accuracy of the SM, we coupled the predicted afterload in the lower extremity arteries during deflation using SM with the 0D-1D patient-specific model. Finally, the simulation results were compared with clinical measurements obtained during EECP therapy to verify the applicability and accuracy of the SM, as well as the coupling method. The precision and reliability of the previously developed personalized approach were further affirmed in this study. The average waveform similarity coefficient between the simulation results and the clinical measurements during the rest state exceeded 90%. This work has the potential to enhance our understanding of the hemodynamic mechanisms involved in EECP treatment and provide valuable insights for clinical decision-making.

Purpose of Review Heart failure is a serious global health problem, and coronary artery disease is one of the main causes. At present, the treatment options for ischemic heart failure (IHF) are limited. This article mainly aims to explore the evidence of enhanced external counterpulsation (EECP) as a non-invasive cardiac rehabilitation method in patients with IHF and to make a preliminary exploration of its mechanisms. Recent Findings According to the existing evidence, the standard course of EECP is safe in patients with IHF and can significantly improve the quality of life of these patients. The effect of EECP on systolic function is still unclear, while EECP has a significant improvement effect on cardiac diastolic function. At the same time, this treatment can reduce the re-hospitalization rate and emergency visit rate of patients within 6 months. In terms of mechanisms, in addition to the immediate hemodynamic effect, existing evidence mostly suggests that its improvement of cardiac function may come from its upregulation of shear stress to improve myocardial perfusion. Summary EECP is safe to use in patients with stable ischemic heart failure, and it can improve the performance status of patients and may be beneficial to cardiac function and reduce the short-term re-hospitalization rate.

As a non-invasive assisted circulation therapy, enhanced external counterpulsation (EECP) has demonstrated potential in treatment of lower-extremity arterial disease (LEAD). However, the underlying hemodynamic mechanism remains unclear. This study aimed to conduct the first prospective investigation of the EECP-induced responses of blood flow behavior and wall shear stress (WSS) metrics in the femoral artery. Twelve healthy male volunteers were enrolled. A Doppler ultrasound-basedapproach was introduced for the in vivo determination of blood flow in the common femoral artery (CFA) and superficial femoral artery (SFA) during EECP intervention, with incremental treatment pressures ranging from 10 to 40 kPa. Three-dimensional subject-specific numerical models were developed in 6 subjects to quantitatively assess variations in WSS-derived hemodynamic metrics in the femoral bifurcation. A mesh-independence analysis was performed. Our results indicated that, compared to the pre-EECP condition, both the antegrade and retrograde blood flow volumes in the CFA and SFA were significantly augmented during EECP intervention, while the heart rate remained constant. The time average shear stress (TAWSS) over the entire femoral bifurcation increased by 32.41%, 121.30%, 178.24%, and 214.81% during EECP with treatment pressures of 10 kPa, 20 kPa, 30 kPa, and 40 kPa, respectively. The mean relative resident time (RRT) decreased by 24.53%, 61.01%, 69.81%, and 77.99%, respectively. The percentage of area with low TAWSS in the femoral artery dropped to nearly zero during EECP with a treatment pressure greater than or equal to 30 kPa. We suggest that EECP is an effective and non-invasive approach for regulating blood flow and WSS in lower extremity arteries.

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.