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Ren Z, Wu Z, Wang Y, Jakhongirkhon I, Zhou Q, Du J. Enhanced External Counterpulsation Intervention Induces the Variation of Physiological Parameters and Shear Stress Metrics in the Carotid Artery. Bioengineering (Basel) 2025; 12:386. [PMID: 40281746 PMCID: PMC12024900 DOI: 10.3390/bioengineering12040386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2025] [Revised: 04/01/2025] [Accepted: 04/02/2025] [Indexed: 04/29/2025] Open
Abstract
Enhanced external counterpulsation (EECP) treatment has been demonstrated to be effectively vasculoprotective and anti-atherosclerotic in clinical observations and controlled trials. The diastolic blood flow augmentation induced by EECP greatly affected the local hemodynamic environment in multiple arterial segments. In this study, a porcine model of hypercholesterolaemia was developed to perform an invasive physiological measurement involving electrocardiogram, blood flow wave, and arterial pressure. Subsequently, a three-dimensional carotid bifurcation model was developed to evaluate the variations in wall shear stress (WSS) and its temporal and spatial oscillations. The results show that, compared to the pre-EECP state, EECP stimulus led to an increase of 28.7% in the common carotid artery (CCA) blood flow volume over a cardiac cycle, as well as an augmentation of 22.73% in the diastolic pressure. Meanwhile, the time-average wall shear stress (TAWSS) over the cardiac cycle increased 25.1%, while the relative residence time (RRT) declined 45.7%. These results may serve to reveal the hemodynamic mechanism of EECP treatment that contributes to its anti-atherosclerotic effects.
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Affiliation(s)
- Zhenfeng Ren
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Key Laboratory of Innovation and Transformation of Advanced Medical Devices, Ministry of Industry and Information Technology, National Medical Innovation Platform for Industry-Education Integration in Advanced Medical Devices (Interdiscipline of Medicine and Engineering), School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China; (Z.R.); (Y.W.)
| | - Zi’an Wu
- Medical Research Center, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 518033, China;
- National Health Commission (NHC) Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou 510080, China
| | - Yanjing Wang
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Key Laboratory of Innovation and Transformation of Advanced Medical Devices, Ministry of Industry and Information Technology, National Medical Innovation Platform for Industry-Education Integration in Advanced Medical Devices (Interdiscipline of Medicine and Engineering), School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China; (Z.R.); (Y.W.)
| | - Israilov Jakhongirkhon
- Department of Public Health and Administration, Tashkent Medical Academy, Tashkent 100109, Uzbekistan;
| | - Qianxiang Zhou
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Key Laboratory of Innovation and Transformation of Advanced Medical Devices, Ministry of Industry and Information Technology, National Medical Innovation Platform for Industry-Education Integration in Advanced Medical Devices (Interdiscipline of Medicine and Engineering), School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China; (Z.R.); (Y.W.)
| | - Jianhang Du
- Medical Research Center, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 518033, China;
- National Health Commission (NHC) Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou 510080, China
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Xu XH, Wang ZB, Zhang Q, Wang JT, Jia X, Hao LL, Lin L, Wu GF, Tian S. The hemodynamic responses to enhanced external counterpulsation therapy in post-PCI patients with a multi-dimension 0/1D-3D model. J Biomech 2025; 179:112487. [PMID: 39709855 DOI: 10.1016/j.jbiomech.2024.112487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 12/09/2024] [Accepted: 12/16/2024] [Indexed: 12/24/2024]
Abstract
Enhanced external counterpulsation (EECP) is widely utilized in rehabilitating patients after percutaneous coronary intervention (PCI) and has demonstrated efficacy in promoting cardiovascular function recovery. Although the precise mechanisms of the therapeutic effects remain elusive, it is widely postulated that the improvement of biomechanical environment induced by EECP plays a critical role. This study aimed to unravel the underlying mechanism through a numerical investigation of the in-stent biomechanical environment during EECP using an advanced multi-dimensional 0/1D-3D coupled model. Physiological data, including age, height, coronary angiography images, and blood velocity profiles of five different arteries, were clinically collected from eleven volunteers both at rest and during EECP. These data contributed the development of a patient-specific 0/1D model to predict the coronary volumetric flow and a 3D stented coronary artery model to capture the detailed in-stent biomechanical features. Specifically, an immersed solid method was introduced to address the numerical challenges of generating computational cells for the 3D model. Simulations revealed that EECP significantly improved the biomechanical environment within the stented arteries, as evidenced by increased time-averaged wall shear stress (resting vs. 20 kPa vs. 30 kPa: 1.39 ± 0.4773 Pa vs. 1.82 ± 0.6856 Pa vs. 1.96 ± 0.7592 Pa, p = 0.0009) and reduced relative residence time (resting vs. 20 kPa vs. 30 kPa: 1.06 ± 0.3926 Pa-1 vs. 0.89 ± 0.3519 Pa-1 vs. 0.87 ± 0.3764 Pa-1, p < 0.0001). Correspondingly, low-WSS/high-RRT surfaces were obviously reduced under EECP. These findings provide deeper insights into EECP's therapeutic mechanisms, thereby offering basis to optimize EECP protocols for enhanced clinical outcomes in post-PCI patients.
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Affiliation(s)
- Xuan-Hao Xu
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518033, China; Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Sun Yat-sen University, Shenzhen, Guangdong 518033, China
| | - Zhi-Bo Wang
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518033, China; Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Sun Yat-sen University, Shenzhen, Guangdong 518033, China
| | - Qi Zhang
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518033, China; College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, Liaoning 110167, China
| | - Jie-Ting Wang
- Department of Ultrasound Medicine, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518033, China
| | - Xue Jia
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518033, China; Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Sun Yat-sen University, Shenzhen, Guangdong 518033, China
| | - Li-Ling Hao
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, Liaoning 110167, China
| | - Ling Lin
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518033, China; Department of Radiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518033, China.
| | - Gui-Fu Wu
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518033, China; Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Sun Yat-sen University, Shenzhen, Guangdong 518033, China.
| | - Shuai Tian
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518033, China; Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Sun Yat-sen University, Shenzhen, Guangdong 518033, China.
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Wang Y, Gao Z, Li Y, Mei S, Tian S, Wu G, Qin KR. Double closed-loop feedback control strategy for enhanced external counterpulsation to regulate hemodynamic response of human common carotid artery. Biomed Signal Process Control 2024; 91:105914. [DOI: 10.1016/j.bspc.2023.105914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Li B, Liu Y, Li G, Zhang Z, Feng Y, Mao B. A real-time patient-specific treatment strategy for enhanced external counterpulsation. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2024; 40:e3808. [PMID: 38409940 DOI: 10.1002/cnm.3808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/23/2024] [Accepted: 02/11/2024] [Indexed: 02/28/2024]
Abstract
Diastolic/systolic blood pressure ratio (D/S) ≥ 1.2 is the gold standard of enhanced external counterpulsation (EECP) treatment, but it does not show a clear clinical correspondence with the configuration of the EECP mode. As such, a single target results in different treatment effects in different individuals. The local haemodynamic effect (wall shear stress, WSS) of EECP on vascular endothelial cells is conducive to promote the growth of collateral circulation vessels and restore the blood supply distal to the stenosis lesion. Considering the haemodynamic effects of WSS on human arteries, this study developed a real-time patient-specific treatment strategy of EECP for patients with cardio-cerebrovascular diseases. Based on patient-specific haemodynamic data from 113 individuals, an optimization algorithm was developed to achieve the individualization of a 0D lumped-parameter model of the human circulatory system, thereby simulating the patient-specific global haemodynamic effects. 0D/3D coupled cardio-cerebrovascular models of two subjects were established to simulate the local WSS. We then established statistical models to evaluate clinically unmeasurable WSS based on measurable global haemodynamic indicators. With the aim of attaining appropriate area- and time-averaged WSS (ATAWSS, 4-7 Pa), as evaluated by global haemodynamic indicators, a closed-loop feedback tuning method was developed to provide patient-specific EECP treatment strategies. Results showed that for clinical data collected from 113 individuals, the individualized 0D model can accurately simulate patient-specific global haemodynamic effects (average error <5%). Based on two subjects, the statistical models can be used to evaluate local ATAWSS (error <6%) for coronary arteries and for cerebral arteries. An EECP mode planned by the patient-specific treatment strategy can promote an appropriate ATAWSS within a 16 s calculation time. The real-time patient-specific treatment strategy of EECP is expected to improve the long-term outcome for each patient and have potential clinical significance.
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Affiliation(s)
- Bao Li
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing, China
| | - Youjun Liu
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing, China
| | - Guangfei Li
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing, China
| | - Zhe Zhang
- Department of Cardiac Surgery, Peking University Third Hospital, Beijing, China
| | - Yue Feng
- Medical Equipment Department, Peking University First Hospital, Beijing, China
| | - Boyan Mao
- Department of Biological Engineering, School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
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Du J, Peng J, Shen X, Li X, Zhong H, Gao Z, Chen M, Qi L, Xie Q. Enhanced external counterpulsation treatment regulates blood flow and wall shear stress metrics in femoral artery: An in vivo study in healthy subjects. J Biomech 2023; 159:111797. [PMID: 37703718 DOI: 10.1016/j.jbiomech.2023.111797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/25/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Abstract
As a non-invasive assisted circulation therapy, enhanced external counterpulsation (EECP) has demonstrated potential in treatment of lower-extremity arterial disease (LEAD). However, the underlying hemodynamic mechanism remains unclear. This study aimed to conduct the first prospective investigation of the EECP-induced responses of blood flow behavior and wall shear stress (WSS) metrics in the femoral artery. Twelve healthy male volunteers were enrolled. A Doppler ultrasound-basedapproach was introduced for the in vivo determination of blood flow in the common femoral artery (CFA) and superficial femoral artery (SFA) during EECP intervention, with incremental treatment pressures ranging from 10 to 40 kPa. Three-dimensional subject-specific numerical models were developed in 6 subjects to quantitatively assess variations in WSS-derived hemodynamic metrics in the femoral bifurcation. A mesh-independence analysis was performed. Our results indicated that, compared to the pre-EECP condition, both the antegrade and retrograde blood flow volumes in the CFA and SFA were significantly augmented during EECP intervention, while the heart rate remained constant. The time average shear stress (TAWSS) over the entire femoral bifurcation increased by 32.41%, 121.30%, 178.24%, and 214.81% during EECP with treatment pressures of 10 kPa, 20 kPa, 30 kPa, and 40 kPa, respectively. The mean relative resident time (RRT) decreased by 24.53%, 61.01%, 69.81%, and 77.99%, respectively. The percentage of area with low TAWSS in the femoral artery dropped to nearly zero during EECP with a treatment pressure greater than or equal to 30 kPa. We suggest that EECP is an effective and non-invasive approach for regulating blood flow and WSS in lower extremity arteries.
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Affiliation(s)
- Jianhang Du
- Medical Research Center, the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 518033, China; National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou 510080, China.
| | - Junping Peng
- Department of Radiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen 518033, China
| | - Xuelian Shen
- Department of Ultrasound, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen 518033, China
| | - Xiaoling Li
- Community Health Service Management Center, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Huiling Zhong
- Medical Research Center, the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 518033, China; National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou 510080, China
| | - Zhuxuan Gao
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang 110819, China
| | - Muyan Chen
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang 110819, China
| | - Lin Qi
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang 110819, China
| | - Qilian Xie
- Department of Pediatrics, Children's Hospital of Anhui Medical University, Hefei 230051, China
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Liu H, Liang H, Yu X, Han Y, Wang G, Yan M, Wang W, Li S. A study on the immediate effects of enhanced external counterpulsation on physiological coupling. Front Neurosci 2023; 17:1197598. [PMID: 37351421 PMCID: PMC10282182 DOI: 10.3389/fnins.2023.1197598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/22/2023] [Indexed: 06/24/2023] Open
Abstract
Introduction Enhanced external counterpulsation (EECP) is a non-invasive assisted circulation technique for its clinical application in the rehabilitation and management of ischemic cardiovascular and cerebrovascular diseases, which has complex physiological and hemodynamic effects. However, the effects of EECP on the coupling of physiological systems are still unclear. We aimed to investigate the immediate effects of EECP on the coupling between integrated physiological systems such as cardiorespiratory and cardiovascular systems. Methods Based on a random sham-controlled design, simultaneous electrocardiography, photoplethysmography, bio-electrical impedance, and continuous hemodynamic data were recorded before, during and after two consecutive 30 min EECP in 41 healthy adults. Physiological coupling strength quantified by phase synchronization indexes (PSI), hemodynamic measurements and heart rate variability indices of 22 subjects (female/male: 10/12; age: 22.6 ± 2.1 years) receiving active EECP were calculated and compared with those of 19 sham control subjects (female/male: 7/12; age: 23.6 ± 2.5 years). Results Immediately after the two consecutive EECP interventions, the physiological coupling between respiratory and cardiovascular systems PSIRES-PTT (0.34 ± 0.14 vs. 0.49 ± 0.17, P = 0.002), the physiological coupling between cardiac and cardiovascular systems PSIIBI-PTT (0.41 ± 0.14 vs. 0.52 ± 0.16, P = 0.006) and the total physiological coupling PSItotal (1.21 ± 0.35 vs. 1.57 ± 0.49, P = 0.005) in the EECP group were significantly lower than those before the EECP intervention, while the physiological coupling indexes in the control group did not change significantly (P > 0.05). Conclusion Our study provides evidence that the PSI is altered by immediate EECP intervention. We speculate that the reduced PSI induced by EECP may be a marker of disturbed physiological coupling. This study provides a new method for exploring the mechanism of EECP action and may help to further optimize the EECP technique.
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Affiliation(s)
- Hongyun Liu
- Research Center for Biomedical Engineering, Medical Innovation Research Division, Chinese PLA General Hospital, Beijing, China
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Beijing, China
| | - Hui Liang
- Department of Hyperbaric Oxygen, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiaohua Yu
- Research Center for Biomedical Engineering, Medical Innovation Research Division, Chinese PLA General Hospital, Beijing, China
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Beijing, China
| | - Yi Han
- Research Center for Biomedical Engineering, Medical Innovation Research Division, Chinese PLA General Hospital, Beijing, China
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Beijing, China
| | - Guojing Wang
- Research Center for Biomedical Engineering, Medical Innovation Research Division, Chinese PLA General Hospital, Beijing, China
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Beijing, China
| | - Muyang Yan
- Department of Hyperbaric Oxygen, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Weidong Wang
- Research Center for Biomedical Engineering, Medical Innovation Research Division, Chinese PLA General Hospital, Beijing, China
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Beijing, China
| | - Shijun Li
- Department of Diagnostic Radiology, First Medical Center, Chinese PLA General Hospital, Beijing, China
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Liu H, Liang H, Yu X, Wang G, Han Y, Yan M, Li S, Wang W. Enhanced external counterpulsation modulates the heartbeat evoked potential. Front Physiol 2023; 14:1144073. [PMID: 37078023 PMCID: PMC10106756 DOI: 10.3389/fphys.2023.1144073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/23/2023] [Indexed: 04/05/2023] Open
Abstract
Introduction: Accumulating evidence suggests that enhanced external counterpulsation (EECP) influences cardiac functions, hemodynamic characteristics and cerebral blood flow. However, little is known about whether or how the EECP affects the brain-heart coupling to produce these physiological and functional changes. We aimed to determine if the brain-heart coupling is altered during or after EECP intervention by assessing the heartbeat evoked potential (HEP) in healthy adults.Methods: Based on a random sham-controlled design, simultaneous electroencephalography and electrocardiography signals as well as blood pressure and flow status data were recorded before, during and after two consecutive 30-min EECP in 40 healthy adults (female/male: 17/23; age: 23.1 ± 2.3 years). HEP amplitude, frequency domain heart rate variability, electroencephalographic power and hemodynamic measurements of 21 subjects (female/male: 10/11; age: 22.7 ± 2.1 years) receiving active EECP were calculated and compared with those of 19 sham control subjects (female/male: 7/12; age: 23.6 ± 2.5 years).Results: EECP intervention caused immediate obvious fluctuations of HEP from 100 to 400 ms after T-peak and increased HEP amplitudes in the (155–169) ms, (354–389) ms and (367–387) ms time windows after T-peak in the region of the frontal pole lobe. The modifications in HEP amplitude were not associated with changes in the analyzed significant physiological measurements and hemodynamic variables.Discussion: Our study provides evidence that the HEP is modulated by immediate EECP stimuli. We speculate that the increased HEP induced by EECP may be a marker of enhanced brain-heart coupling. HEP may serve as a candidate biomarker for the effects and responsiveness to EECP.
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Affiliation(s)
- Hongyun Liu
- Research Center for Biomedical Engineering, Medical Innovation Research Division, Chinese PLA General Hospital, Beijing, China
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Beijing, China
- *Correspondence: Hongyun Liu, ; Muyang Yan, ; Shijun Li, ; Weidong Wang,
| | - Hui Liang
- Department of Hyperbaric Oxygen, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiaohua Yu
- Research Center for Biomedical Engineering, Medical Innovation Research Division, Chinese PLA General Hospital, Beijing, China
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Beijing, China
| | - Guojing Wang
- Research Center for Biomedical Engineering, Medical Innovation Research Division, Chinese PLA General Hospital, Beijing, China
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Beijing, China
| | - Yi Han
- Research Center for Biomedical Engineering, Medical Innovation Research Division, Chinese PLA General Hospital, Beijing, China
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Beijing, China
| | - Muyang Yan
- Department of Hyperbaric Oxygen, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Hongyun Liu, ; Muyang Yan, ; Shijun Li, ; Weidong Wang,
| | - Shijun Li
- Department of Diagnostic Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Hongyun Liu, ; Muyang Yan, ; Shijun Li, ; Weidong Wang,
| | - Weidong Wang
- Research Center for Biomedical Engineering, Medical Innovation Research Division, Chinese PLA General Hospital, Beijing, China
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Beijing, China
- *Correspondence: Hongyun Liu, ; Muyang Yan, ; Shijun Li, ; Weidong Wang,
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Zeng CM, Zhao YM, Zhong XJ, Wu ZJ, Bai J, Qiu SY, Li YY. Reduction in risk of contrast-induced nephropathy in patients with chronic kidney disease and diabetes mellitus by enhanced external counterpulsation. Front Endocrinol (Lausanne) 2022; 13:973452. [PMID: 36325451 PMCID: PMC9618591 DOI: 10.3389/fendo.2022.973452] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of enhanced external counterpulsation (EECP) in the prevention of contrast-induced nephropathy (CIN) in patients with combined chronic kidney disease (CKD) and diabetes mellitus (DM) by comparing the changes in renal function-related indicators in patients before and after coronary angiography (CAG) or percutaneous coronary intervention (PCI). METHODS There were 230 subjects consecutively included in the study. Of these, 30 cases with DM underwent rehydration therapy, and 200 cases underwent EECP therapy in addition to rehydration therapy, comprising 53 patients with DM and 147 patients without. All the patients were tested to measure the renal function indicators before and after CAG/PCI. RESULTS The postoperative results of blood urea nitrogen (BUN), serum creatinine (Scr), estimated glomerular filtration rate (eGFR), B2 microglobulin, and high-sensitivity C-reactive protein in the three groups showed a statistically significant difference (P < 0.05). After EECP therapy, patients with DM showed a significant decrease in BUN (9.1 ± 4.2 vs. 7.2 ± 3.0, t = 3.899, P < 0.001) and a significant increase in eGFR (41.5 ± 12.7 vs. 44.0 ± 15.6, t = -2.031, P = 0.047), while the patients without DM showed a more significant difference (P < 0.001). Patients with DM showed a lower percentage of elevated Scr (66.7% vs. 43.4%, P = 0.042), a higher percentage of elevated eGFR (30.0% vs. 52.8%, P = 0.044), and a lower incidence of CIN (16.7% vs. 3.8%, P = 0.042) after EECP therapy. CONCLUSION Treatment with EECP can reduce Scr in patients with combined CKD and DM post CAG/PCI, increase eGFR, and decrease the incidence of CIN.
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Wang H, Balzani D, Vedula V, Uhlmann K, Varnik F. On the Potential Self-Amplification of Aneurysms Due to Tissue Degradation and Blood Flow Revealed From FSI Simulations. Front Physiol 2021; 12:785780. [PMID: 34955893 PMCID: PMC8709128 DOI: 10.3389/fphys.2021.785780] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
Tissue degradation plays a crucial role in the formation and rupture of aneurysms. Using numerical computer simulations, we study the combined effects of blood flow and tissue degradation on intra-aneurysm hemodynamics. Our computational analysis reveals that the degradation-induced changes of the time-averaged wall shear stress (TAWSS) and oscillatory shear index (OSI) within the aneurysm dome are inversely correlated. Importantly, their correlation is enhanced in the process of tissue degradation. Regions with a low TAWSS and a high OSI experience still lower TAWSS and higher OSI during degradation. Furthermore, we observed that degradation leads to an increase of the endothelial cell activation potential index, in particular, at places experiencing low wall shear stress. These findings are robust and occur for different geometries, degradation intensities, heart rates and pressures. We interpret these findings in the context of recent literature and argue that the degradation-induced hemodynamic changes may lead to a self-amplification of the flow-induced progressive damage of the aneurysmal wall.
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Affiliation(s)
- Haifeng Wang
- Theory and Simulation of Complex Fluids, Department of Scale-Bridging Thermodynamic and Kinetic Simulation, Interdisciplinary Center for Advanced Materials Simulation (ICAMS), Ruhr-Universität Bochum, Bochum, Germany
| | - Daniel Balzani
- Department of Civil and Environmental Engineering, Chair of Continuum Mechanics, Ruhr-Universität Bochum, Bochum, Germany
| | - Vijay Vedula
- Department of Mechanical Engineering, Columbia University in the City of New York, New York, NY, United States
| | - Klemens Uhlmann
- Department of Civil and Environmental Engineering, Chair of Continuum Mechanics, Ruhr-Universität Bochum, Bochum, Germany
| | - Fathollah Varnik
- Theory and Simulation of Complex Fluids, Department of Scale-Bridging Thermodynamic and Kinetic Simulation, Interdisciplinary Center for Advanced Materials Simulation (ICAMS), Ruhr-Universität Bochum, Bochum, Germany
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