Evaluation of Enhanced External Counterpulsation with Different Modes on the Acute Hemodynamic Effects

Yujia Zhong¹Liling Hao^1*Xue Jia²Songrim Paek¹Shuai Tian²Guifu Wu^2*

• ¹College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
• ²Department of Cardiology, The Eight Affiliated Hospital, Sun Yat-sen University, Shenzhen, China

Objective: Enhanced external counterpulsation (EECP) is a noninvasive device for the treatment of cardiovascular diseases. However, there is minimal data regarding the effects of different EECP modes on the acute hemodynamic changes, particularly the blood flow redistribution. This study aimed to investigate the systemic hemodynamic effects during different EECP modes based on the clinical trials and numerical analysis.Methods: Fifteen patients with cardiovascular disease and fifteen healthy subjects completed four and six EECP modes respectively. These EECP modes changes the parameters including counterpulsation pressure, start time, and counterpulsation frequency. Hemodynamic parameters in the aorta (AO), right femoral artery (RF), and right brachial artery (RB), including mean flow rate (FR), mean blood velocity (MV), peak systolic velocity (PSV), minimum diastolic velocity (MDV), and diastolic/systolic blood pressure ratio (D/S) were measured during EECP treatments. Meanwhile, the simulations of hemodynamic responses to different EECP modes based on a 0D-1D cardiovascular system model were conducted and compared with the clinical results.As counterpulsation pressure increased, FR and PSV of AO, FR, MV, PSV and MDV of RF, FR, MV, and MDV of RB, and D/S increased in patients (all P < 0.05). MV of RF and FR, MV, PSV and MDV of RB, and D/S of patients decreased significantly with increasing start time (all P < 0.05). For the increase of counterpulsation frequency, FR, MV, and PSV of AO, MV, PSV, and MDV of RF, FR and MV of RB significantly decreased in patients (all P < 0.05). For the health group, most of results were similar with patients. Multiple groups of pressure experiments indicated that 25 kPa-30 kPa significantly improved the blood flow. The numerical results under different EECP modes were generally closely aligned with clinical measurements.Different EECP modes induced different hemodynamic responses. Higher counterpulsation pressure, T wave start time, and 1:1 counterpulsation frequency are recommended to improve blood flow. Hemodynamic simulations prepare the way for the creation of virtual databases to obtain population-based strategies, and then allow for precision-based strategies through individual modelling. The different hemodynamic responses to EECP modes provide theoretical guidance for the development of patient-specific treatment strategy.