Levenson Jaime, Simon Alain, Megnien Jean L, Chironi Gilles, Gariepy Jerome, Pernollet Marie G, Craiem Damian, Iliou Marie C
Centre de Médecine Préventive Cardiovasculaire, Hôpital Broussais/Hôpital Européen Georges Pompidou, Faculté de Médecine René Descartes Paris 5, France.
Cardiology. 2007;108(2):104-10. doi: 10.1159/000095949. Epub 2006 Sep 29.
Enhanced external counterpulsation (EECP) is a noninvasive method previously shown to improve measures of myocardial ischemia in patients with coronary artery disease. However, the concomitant effects of EECP on large and small arterial properties have been poorly examined. In a randomized controlled study, we investigated whether arterial stiffness and resistance of the carotid circulation are altered by EECP.
Thirty patients with angiographically demonstrated coronary artery disease were randomized into two groups to receive either 'sham' or active EECP therapy for 35 1-hour sessions. The beta stiffness index was calculated by the ln(Ps/Pd)/DD equation where Ps and Pd = systolic and diastolic blood pressure, and DD = the ratio between carotid pulse and diastolic diameter, measured by ultrasound sequential frames during the cardiac cycle. Carotid vascular resistance was calculated as the ratio between mean arterial pressure and mean common carotid blood flow.
No significant between-group differences were seen in clinical characteristics or carotid hemodynamics at baseline. The beta stiffness index and carotid vascular resistance were significantly reduced after 35 h of active EECP (p < 0.01), and the decrease was significantly different when compared with controls (p < 0.05 for beta stiffness index and p < 0.001 for carotid vascular resistance). These reductions persisted after multiple covariate adjustment.
This study suggests that EECP exerts clear arterial effects on large and small vessels of the carotid circulation. The combined effects on arterial stiffness and vascular resistance are of particular interest in cardiovascular disease involving reduction in blood flow, in which techniques that increase regional blood flow may be beneficial.
增强型体外反搏（EECP）是一种无创方法，此前已证明可改善冠心病患者的心肌缺血指标。然而，EECP对大、小动脉特性的伴随影响尚未得到充分研究。在一项随机对照研究中，我们调查了EECP是否会改变颈动脉循环的动脉僵硬度和阻力。
30例经血管造影证实患有冠心病的患者被随机分为两组，分别接受“假”治疗或积极的EECP治疗，为期35个1小时疗程。β僵硬度指数通过ln(Ps/Pd)/DD方程计算，其中Ps和Pd分别为收缩压和舒张压，DD为颈动脉搏动与舒张期直径之比，通过心动周期中的超声序列帧测量。颈动脉血管阻力计算为平均动脉压与平均颈总动脉血流之比。
基线时，两组在临床特征或颈动脉血流动力学方面未见显著差异。积极的EECP治疗35小时后，β僵硬度指数和颈动脉血管阻力显著降低（p < 0.01），与对照组相比，降低具有显著差异（β僵硬度指数p < 0.05，颈动脉血管阻力p < 0.001）。经过多次协变量调整后，这些降低仍然存在。
本研究表明，EECP对颈动脉循环的大、小血管具有明显的动脉效应。对动脉僵硬度和血管阻力的综合影响在涉及血流减少的心血管疾病中尤为重要，在这类疾病中，增加局部血流的技术可能有益。
