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Long-term hemodynamic mechanism of enhanced external counterpulsation in the treatment of coronary heart disease: a geometric multiscale simulation

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Abstract

Enhanced external counterpulsation (EECP) is a noninvasive treatment method for coronary artery atherosclerosis that acts on the vascular endothelial cells. The intracoronary hemodynamic parameters that influence long-term treatment effect are the fundamental factors for the inhibition of intimal hyperplasia, which cannot be measured in real time. In order to optimize the long-term treatment effect of coronary heart disease, it is necessary to establish a method for quantified calculation of intracoronary hemodynamic parameters during counterpulsation to research the long-term hemodynamic mechanism of EECP. A geometric multiscale model coupled by the zero-dimensional (0D) lumped parameter model and the three-dimensional (3D) model of narrow coronary artery was established for the simulation of intracoronary hemodynamic environment. The 3D model was used to calculate the hemodynamic parameters such as wall shear stress (WSS) and oscillatory shear index (OSI), while the 0D model was used to simulate the blood circulatory system. Sequential pressure was applied to calves, thighs, and buttocks module in 0D model with the consideration of vessel collapse. Hemodynamic performance was compared with clinical reports to verify the effectiveness of the method. There were significant increases of the diastolic blood pressure (DBP), coronary flow, and the area-averaged WSS during application of EECP, while OSI behind stenosis has some decrease. The waveforms of coronary flow has good similarity with the clinical measured waveforms, and the differences between calculated mean arterial pressures (MAPs) and clinical measurements were within 1%. The fundamental factor in the cure of coronary heart disease by EECP is the improvement of WSS and the decrease of OSI. Comparing with the clinical reports, the immediate hemodynamic changes demonstrate the effectiveness of model. Intracoronary hemodynamic parameters during EECP could be acquired and the method could be used to simulate the long-term treatment effect of EECP.

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Funding

This research was supported by the National Natural Science Foundation of China (11832003, 11772016, 11472022, 11702008), the Key Project of Science and Technology of Beijing Municipal Education Commission (KZ201810005007), the Support Plan for High-level Faculties in Beijing Municipal Universities (CIT&TCD201804011), and the Beijing Excellent Talents Funds (2017000020124G277).

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Authors and Affiliations

  1. College of Life Science and Bioengineering, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang District, Beijing, 100124, People’s Republic of China

    Bao Li, Wenxin Wang, Boyan Mao, Haisheng Yang & Youjun Liu

  2. School of Biological Science and Medical Engineering, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing, 100083, China

    Haijun Niu

  3. The Eighth Affiliated Hospital, Sun Yat-sen University, No.3025 ShenNan Road, Shenzhen, 518033, Guangdong, China

    Jianhang Du & Xiaoling Li

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  1. Bao Li
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Correspondence to Youjun Liu.

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Li, B., Wang, W., Mao, B. et al. Long-term hemodynamic mechanism of enhanced external counterpulsation in the treatment of coronary heart disease: a geometric multiscale simulation. Med Biol Eng Comput 57, 2417–2433 (2019). https://doi.org/10.1007/s11517-019-02028-4

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