Buschmann Eva-Elina, Brix Michele, Li Lulu, Doreen Janke, Zietzer Andreas, Li Meijing, Buschmann Ivo, Hillmeister Philipp
1 , Department for Angiology, Brandenburg/ Havel, Germany.
3 Department of Physiology, Charité Benjamin Franklin Berlin, Germany.
Vasa. 2016;45(4):317-24. doi: 10.1024/0301-1526/a000544.
External counterpulsation therapy enhances blood flow and was shown to improve endothelial function and quality of life in coronary artery disease patients. However, high pressures of up to 300 mmHg may lead to malperfusion of the ischaemic limb. To improve the clinical outcome of patients with peripheral artery disease (PAD), we adjusted external counterpulsation and developed a novel non-invasive approach termed individual shear rate therapy (ISRT).
In the present study, 14 patients with a Fontaine stage IIb and femoral-popliteal PAD underwent 30 hours of ISRT over 5 weeks. For ISRT, individual treatment pressures that do not exceed 160 mmHg were assessed by Doppler flow parameters during counterpulsation (individual shear rate diagnosis) in order to enhance and maximise peripheral perfusion. The study aimed to enhance peripheral perfusion and evaluate the primary clinical endpoint endothelial function, as well as to perform preliminary analysis of the ankle brachial index (ABI) and walking distance.
Doppler flow measurements in the lower limb (ankle) validated that maximum blood flow velocity during systole and acceleration doubled during ISRT. Study results demonstrated that long-term ISRT significantly increased flow-mediated dilation (FMD) in the brachial artery (0.13+/- 0.09 mm to 0.38+/- 0.05 mm; p < 0.05), while nitromediated dilation (0.36+/- 0.10 mm to 0.45+/- 0.08 mm) remained and common femoral artery FMD did not reach statistical significance (0.38+/- 0.08 mm to 0.67+/- 0.19 mm; p<0.05). Initial claudication distance considerably improved for all patients after 30 hours of ISRT (92.6 +/- 8.2 metres to 280+/- 101.3 metres, p<0.05), just like the absolute claudication distance, which showed a more than 2.5-fold increase (167.8+/- 18.1 metres to 446.7+/- 133.3 metres; p<0.05). The ABI did not improve (0.58+/- 0.03 to 0.65+/- 0.04).
Our data demonstrate that long-term ISRT is a potential novel non-invasive treatment to improve endothelial function and absolute pain-free walking distance for PAD patients.
体外反搏疗法可增强血流，已被证明能改善冠心病患者的内皮功能和生活质量。然而，高达300 mmHg的高压可能导致缺血肢体灌注不良。为改善外周动脉疾病（PAD）患者的临床结局，我们调整了体外反搏并开发了一种名为个体剪切率疗法（ISRT）的新型非侵入性方法。
在本研究中，14例处于Fontaine IIb期且患有股腘动脉PAD的患者在5周内接受了30小时的ISRT治疗。对于ISRT，在反搏过程中通过多普勒血流参数（个体剪切率诊断）评估不超过160 mmHg的个体治疗压力，以增强并最大化外周灌注。该研究旨在增强外周灌注并评估主要临床终点内皮功能，以及对踝肱指数（ABI）和步行距离进行初步分析。
下肢（踝部）的多普勒血流测量证实，在ISRT期间，收缩期最大血流速度和加速度增加了一倍。研究结果表明，长期ISRT可显著增加肱动脉的血流介导的血管舒张（FMD）（从0.13±0.09 mm增至0.38±0.05 mm；p<0.05），而硝酸酯介导的血管舒张（从0.36±0.10 mm增至0.45±0.08 mm）保持不变，股总动脉FMD未达到统计学显著性（从0.38±0.08 mm增至0.67±0.19 mm；p<0.05）。所有患者在接受30小时的ISRT治疗后，初始跛行距离显著改善（从92.6±8.2米增至280±101.3米，p<0.05），绝对跛行距离也是如此，显示增加了2.5倍以上（从167.8±18.1米增至446.7±133.3米；p<0.05）。ABI未改善（从0.58±0.03降至0.65±0.04）。
我们的数据表明，长期ISRT是一种潜在的新型非侵入性治疗方法，可改善PAD患者的内皮功能和绝对无痛步行距离。
