Enhanced external counterpulsation for heart health
2021-03-16
Enhanced external counter pulsation (EECP) is a noninvasive circulatory method for the treatment of ischemic diseases. Since the late 1970s, it has been widely used in the treatment of ischemic heart disease and stroke in China. In 1994, the FDA confirmed that EECP could be used in the treatment of stable and unstable angina, acute myocardial infarction and cardiogenic shock. In 2002, congestive heart failure was included in its indications.
In 2013, the European Society of Cardiology included EECP therapy (IIA) in the guidance for the diagnosis and treatment of stable coronary heart disease. Cardiovascular rehabilitation is to control cardiovascular risk factors, reduce symptoms, improve exercise tolerance and quality of life by comprehensive intervention means, such as drugs, sports, nutrition, education, psychological and lifestyle changes, so as to reduce acute cardiovascular events and cardiovascular related deaths. EECP can increase coronary blood flow, promote the formation of coronary collateral circulation and improve exercise tolerance. Some scholars call EECP passive "movement".
● Immediate hemodynamic effect of EECP
The basic principle of EECP is similar to that of intra aortic balloon pump (IABP). The biggest difference is that EECP can squeeze the lower extremity veins simultaneously, increase the flow of blood back to the heart and improve the output of heart. The main part of IABP is to reduce the main artery. EECP can produce higher diastolic boost wave, and the amplitude of increasing the pressurisation wave in diastolic period is 26% - 157%.
The effect of EECP on arterial systolic pressure is different, which can reduce the systolic pressure by 9-16mmhg (1mmhg = 0.133kpa, with a decrease of 6.3% - 11.0%). The EECP can increase cardiac output by 5% - 50% (average 25%) on the premise of the decrease of left ventricular ejection resistance.
● EECP Mechanism
EECP treatment can accelerate the blood flow rate of the artery and improve the shear stress of the vascular endothelium in addition to the immediate hemodynamic changes mentioned above. It can be realized by acting on the endovascular cells for a long time, which is shown in the following aspects:
The levels of NO(nitric oxide) in circulation and endothelin-1 (ET-1) decreased in patients with coronary heart disease after EECP;
Inhibition of inflammatory substances release: the study of casy et al. Confirmed that 35h EECP treatment can reduce the levels of TNF α and monocyte chemoattractant protein-1 (MCP-1) in circulation by 29% and 20% respectively, which is consistent with the improvement of clinical symptoms;
The molecular mechanism of the inhibition of intimal proliferation and atherosclerosis damage, the abnormal increase of mitogen activated protein kinase (MAPK) family activity, the inhibition of nf- kappa β overexactivation, the strong endothelial nitric oxide synthetase (eNOS) / no pathway, and the down regulation of integrin β 1 in endothelial cells It is related to the expression of CTGF gene;
01. What is the principle of EECP in the treatment of myocardial infarction?
The treatment of EECP can improve the function of intima and form a stable road for the blood vessels formed naturally by improving the quantity of coronary artery and perfusion of blood flow in the ischemic region, rescuing the ischemic myocardium, avoiding or narrowing myocardial infarction.
02. Can EECP treat hypertension and solve hyperlipidemia?
External counterpulsation can improve the endothelial function, make the blood vessels stretch and contract, thus tend to balance, increase the blood flow stress of peripheral vessels, thus reducing blood pressure and significantly reducing the dosage of antihypertensive drugs.
By accelerating blood circulation and promoting metabolism, cardioplegia can transport harmful LDL cholesterol to liver and eliminate it by bile, and increase the high-density lipoprotein cholesterol which is beneficial to human body.
03. Does EECP be effective in the treatment of diabetes?
It is effective for the treatment of non insulin-dependent diabetes. On the one hand, the EECP machine increases blood perfusion of pancreatic organs, improves microcirculation of pancreatic organs, on the other hand, promotes the metabolism of sugar and interferes with insulin resistance. At present, it is considered that cardiopulmonary bypass is one of the best treatment methods for diabetic complicated with coronary heart disease. It is considered that cardioplegia is one of the best treatment methods for diabetic complicated with retinopathy and peripheral microvascular disease And external counterpulsation also has a positive auxiliary effect.
04. Is EECP helpful to the prevention of cardiovascular and cerebrovascular diseases?
Mental imbalance, malnutrition and lack of exercise cause long-term blood stasis, poor flow, narrow blood vessels, and deposition of more and more harmful substances, which can easily cause cardiovascular and cerebrovascular diseases. Besides drugs and improvement of living habits, the best advice is to participate in physical exercises, but most of the people are difficult to keep on with scientific exercise, and external counterpulsion can be used to Without increasing the heart load, it is a new way to prevent cardiovascular and cerebrovascular diseases to increase blood perfusion in important organs such as heart, brain and kidney, promote blood circulation, accelerate metabolism, improve immunity, increase blood flow and achieve smooth blood.
In short, EECP, as a non-invasive non exercise therapy, can protect the heart and improve the exercise tolerance, and improve the safety of the treatment. Meanwhile, EECP treatment can improve the heart function and the pathophysiological environment of the whole body, so that patients who have experienced a series of EECP treatment can actively participate in sports rehabilitation training, which greatly improves the compliance and clinical benefits of cardiovascular rehabilitation.
