Abstract
Traditional enhanced external counterpulsation (EECP) used for the clinical treatment of patients with coronary heart disease only assesses diastolic/systolic blood pressure (Q = D/S > 1.2). However, improvement of the hemodynamic environment surrounding vascular endothelial cells of coronary arteries after long-term application of EECP is the basis of the treatment. Currently, the quantitative hemodynamic mechanism is not well understood. In this study, a standard 0D/3D geometric multi-scale model of the coronary artery was established to simulate the hemodynamic effects of different counterpulsation modes on the vascular endothelium. In this model, the neural regulation caused by counterpulsation was thoroughly considered. Two clinical trials were carried out to verify the numerical calculation model. The results demonstrated that the increase in counterpulsation pressure amplitude and pressurization duration increased coronary blood perfusion and wall shear stress (WSS) and reduced the oscillatory shear index (OSI) of the vascular wall. However, the impact of pressurization duration was the predominant factor. The results of the standard model and the two real individual models indicated that a long pressurization duration would cause more hemodynamic risk areas by resulting in excessive WSS, which could not be reflected by the change in the Q value. Therefore, long-term pressurization during each cardiac cycle therapy is not recommended for patients with coronary heart disease and clinical treatment should not just pay attention to the change in the Q value. Additional physiological indicators can be used to evaluate the effects of counterpulsation treatment.
Highlights
Enhanced external counterpulsation (EECP) is a non-invasive method that uses air-inflated cuffs to mechanically compress the human lower body and increase the diastolic blood pressure (DBP)
It was found that within the counterpulsation pressure range associated with the clinical applications, the increasing pressure amplitude of the three parts resulted in a slight upward trend in the mean arterial pressure (MAP) and the coronary artery flow (CAF)
When the pressure was greater than the critical value, the acute hemodynamic effects exhibited little improvement
Summary
Enhanced external counterpulsation (EECP) is a non-invasive method that uses air-inflated cuffs to mechanically compress the human lower body and increase the diastolic blood pressure (DBP). This decreases compression at the onset of systole and decreases the vascular resistance to reduce the intra-aortic systolic blood pressure (SBP) (Applebaum et al, 1997). Cardiac output (CO) is improved due to increased blood flow return to the heart. The pressure is released, reducing the distal afterload of the heart and accelerating the blood flow to the global circulation, thereby achieving a counterpulsation effect
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