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.
Highlights
Enhanced external counterpulsation (EECP) is a noninvasive treatment for patients with cardiovascular disease [1–3]
The major findings in this study are 2-fold: first, EECP-3 immediately improved the blood flow, blood flow velocity, and ACCs of the anterior tibial artery; second, EECP-1 and EECP-2 significantly increased the blood flow velocity and peripheral resistance of the inferior knee artery, whereas they markedly reduce the blood flow in the posterior tibial artery
We found that EECP significantly increased the Flow rate (FR) of the anterior tibial artery and that the FR of the anterior tibial artery was significantly higher than that of the other arteries
Summary
Enhanced external counterpulsation (EECP) is a noninvasive treatment for patients with cardiovascular disease [1–3]. Studies have reported that EECP alleviates symptoms of angina and reduces myocardial ischemia [4–6] but that it is beneficial to peripheral vascular function [7–9]. Braith et al found that EECP significantly increases peripheral artery flow-mediated dilation (FMD) and promotes endothelialderived vasoactive agents [9]. Nichols et al demonstrated that EECP reduces arterial stiffness and improves wave reflection characteristics [7]. Zhang et al found that EECP decreases resistance index in the common carotid artery [10]. Gurovich et al demonstrated that EECP-induced blood flow patterns improve endothelial function in peripheral muscular conduit arteries [11]. Avery et al found that EECP significantly elevates peak limb blood flow and improves endothelium-dependent vasodilation in calf resistance arteries [12]
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