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. 2021 Dec 24:8:795697.
doi: 10.3389/fcvm.2021.795697. eCollection 2021.

Effects of Enhanced External Counterpulsation With Different Sequential Levels on Lower Extremity Hemodynamics

Yahui Zhang  1   2   3 , Yujia Zhang  1   2   3 , Yinfen Wang  1 , Xiuli Xu  1   2   3 , Jing Jin  1 , Xiaodong Zhang  4 , Wei Zhang  5 , Wenbin Wei  1 , Chubin Zhong  6 , Guifu Wu  1   2   3
Affiliations

Effects of Enhanced External Counterpulsation With Different Sequential Levels on Lower Extremity Hemodynamics

Yahui Zhang et al. Front Cardiovasc Med. .

Abstract

Objective: This study aimed to investigate acute hemodynamics of lower extremities during enhanced external counterpulsation with a three-level sequence at the hips, thighs, and calves (EECP-3), two-level sequence at the hips and thighs (EECP-2), and single leg three-level sequence (EECP-1). Methods: Twenty healthy volunteers were recruited in this study to receive a 45-min EECP intervention. Blood flow spectrums in the anterior tibial artery, posterior tibial artery, and dorsalis pedis artery were imaged by Color Doppler ultrasound. Mean flow rate (FR), area, pulsatility index (PI), peak systolic velocity (PSV), end-diastolic velocity (EDV), mean flow velocity (MV), and systolic maximum acceleration (CCAs) were sequentially measured and calculated at baseline during EECP-3, EECP-1, and EECP-2. Results: During EECP-3, PI, PSV, and MV in the anterior tibial artery were significantly higher, while EDV was markedly lower during EECP-1, EECP-2, and baseline (all P < 0.05). Additionally, ACCs were significantly elevated during EECP-3 compared with baseline. Moreover, FR in the anterior tibial artery was significantly increased during EECP-3 compared with baseline (P = 0.048). During EECP-2, PI and MV in the dorsalis pedis artery were significantly higher and lower than those at baseline, (both P < 0.05). In addition, FR was markedly reduced during EECP-2 compared with baseline (P = 0.028). During EECP-1, the area was significantly lower, while EDV was markedly higher in the posterior tibial artery than during EECP-1, EECP-2, and baseline (all P < 0.05). Meanwhile, FR of the posterior tibial artery was significantly reduced compared with baseline (P = 0.014). Conclusion: Enhanced external counterpulsation with three-level sequence (EECP-3), EECP-2, and EECP-1 induced different hemodynamic responses in the anterior tibial artery, dorsalis pedis artery, and posterior tibial artery, respectively. EECP-3 acutely improved the blood flow, blood flow velocity, and ACCs of the anterior tibial artery. In addition, EECP-1 and EECP-2 significantly increased the blood flow velocity and peripheral resistance of the inferior knee artery, whereas they markedly reduced blood flow in the posterior tibial artery.

Keywords: blood flow; enhanced external counterpulsation; hemodynamic responses; lower extremity arteries; sequential level.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the whole experimental scheme.
Figure 2
Figure 2
Ultrasound pictures and Doppler spectrum of the anterior tibial artery at baseline, during EECP-3, EECP-1, and EECP-2.
Figure 3
Figure 3
Significant changes in the anterior tibial artery, posterior tibial artery, and dorsalis pedis artery at baseline, during EECP-3, EECP-2, and EECP-1. a. significant differences between the anterior tibial artery and posterior tibial artery; b. significant difference between dorsalis pedis artery and posterior tibial artery; c. significant differences between the anterior tibial artery and dorsalis pedis artery.
Figure 4
Figure 4
Effect of EECP-3, EECP-2 and EECP-1 on the flow rate (FR) of posterior tibial artery (A), anterior tibial artery (B) and dorsalis pedis artery (C).
Figure 5
Figure 5
Effect of EECP-3, EECP-2 and EECP-1 on the area of posterior tibial artery (A), anterior tibial artery (B) and dorsalis pedis artery (C).
Figure 6
Figure 6
Effect of EECP-3, EECP-2 and EECP-1 on the pulsatility index (PI) of posterior tibial artery (A), anterior tibial artery (B) and dorsalis pedis artery (C).
Figure 7
Figure 7
Effect of EECP-3, EECP-2 and EECP-1 on the peak systolic velocity (PSV) of posterior tibial artery (A), anterior tibial artery (B) and dorsalis pedis artery (C).
Figure 8
Figure 8
Effect of EECP-3, EECP-2 and EECP-1 on the end-diastolic velocity (EDV) of posterior tibial artery (A), anterior tibial artery (B) and dorsalis pedis artery (C).
Figure 9
Figure 9
Effect of EECP-3, EECP-2 and EECP-1 on the mean flow velocity (MV) of posterior tibial artery (A), anterior tibial artery (B) and dorsalis pedis artery (C).
Figure 10
Figure 10
Effect of EECP-3, EECP-2 and EECP-1 on the systolic maximum acceleration (CCAs) of posterior tibial artery (A), anterior tibial artery (B) and dorsalis pedis artery (C).
See this image and copyright information in PMC

References

    1. Masuda D, Nohara R, Hirai T, Kataoka K, Chen LG, Hosokawa R, et al. Enhanced external counterpulsation improved myocardial perfusion and coronary flow reserve in patients with chronic stable angina; evaluation by(13)N-ammonia positron emission tomography. Eur Heart J. (2001) 22:1451–8. 10.1053/euhj.2000.2545 - DOI - PubMed
    1. Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. (2012) 60:e44–e164. 10.1016/j.jacc.2012.07.013 - DOI - PubMed
    1. Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. (2013) 34:2949–3003. 10.1093/eurheartj/eht296 - DOI - PubMed
    1. Wu E, Desta L, Broström A, Mårtensson J. Effectiveness of enhanced external counterpulsation treatment on symptom burden, medication profile, physical capacity, cardiac anxiety, and health-related quality of life in patients with refractory angina pectoris. J Cardiovasc Nurs. (2020) 35:375–85. 10.1097/JCN.0000000000000638 - DOI - PubMed
    1. Caceres J, Atal P, Arora R, Yee D. Enhanced external counterpulsation: A unique treatment for the “No-Option” refractory angina patient. J Clin Pharm Ther. (2021) 46:295–303. 10.1111/jcpt.13330 - DOI - PMC - PubMed