Effect of enhanced external counterpulsation versus individual shear rate therapy on the peripheral artery functions

Abstract

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.

Keywords: Enhanced external counterpulsation; Individual shear rate therapy; Lower extremity atherosclerotic disease; Vascular hemodynamics; Walking distance.

Fig. 1

Flowchart of study participants.

Fig. 2

A flow diagram of outcomes at each testing time point.

Fig. 3

Comparison of brachial-FMD and 6-min walk test before and after intervention in. EECP, ISRT and control group (“*” indicates the comparison within each group, p < 0.01, “+” indicates the difference between groups, p < 0.01).

Fig. 4

Flow rate changes of popliteal artery (a), posterior tibial artery (b), anterior. tibial artery (c) and dorsalis pedis artery (d) before and after intervention in EECP, ISRT and control groups (“*” indicates the significant comparison within each group. “*” and “**” denote p < 0.5 and < 0.01 respectively. “+” and “++” denote p-values of the difference between groups < 0.5 and < 0.01 respectively).

Fig. 5

Comparison of biochemical assays before and after intervention in EECP, ISRT and control group (“*” indicates the comparison within each group, p < 0.01, “+” indicates the difference between groups, p < 0.01).

Fig. 6

Associations between clinical indices. Heat map of the Spearma’s rank correlation coefficient between 44 clinical indices. n = 35; *P < 0.05; **P < 0.01; Spearman’s rank correlation.