PHYSIOLOGIC RESPONSE TO EXTERNAL COUNTERPULSATION (ECP)

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。体外反搏(ECP)是一种非侵入性、广为接受的改善冠脉血流灌注和改善严重冠心病患者血流动力学的方法。它包括在七周内进行35次一小时的治疗，在舒张期，腿部和下腹部周围的一系列大型气动袖口被充气和排气。这可以改善舒张期血流灌注和血流动力学，其方式类似于主动脉内球囊反搏。虽然已经证实了ECP的一些临床益处，但ECP的生理作用机制尚不清楚。我们推测ECP的全身性血管效应包括改善内皮功能、减轻炎症和改善血小板功能是ECP临床获益的原因。此外，我们假设，第二个效应是改善心理健康。这项研究的总体目标是通过测量血管特性的变化来阐明ECP的生理作用，包括血管内皮功能(通过对充血的臂动脉反应)、动脉僵硬(通过主动脉脉搏波速度)和外周血管健康(通过踝臂指数)。此外，我们还将测量炎症的血液学标志物、纤溶状态、血小板聚集的功能研究和内皮起源的分子。将使用24小时动态心电图监测来评估心脏的电生理重构。心理幸福感将使用SF-36问卷进行测量。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Extracorporeal counterpulsion (ECP) is a non-invasive and well-accepted method of improving coronary perfusion and improving hemodynamics in patients with severe CAD. It consists of 35 one-hour treatments over seven weeks in which a series of large pneumatic cuffs around the legs and lower abdomen are inflated and deflated during diastole. This improves diastolic perfusion and hemodynamics in a similar fashion to an intra-aortic balloon pump. Although some clinical benefits have been demonstrated, the physiological mechanisms of action of ECP are poorly understood. We hypothesized that the systemic vascular effects of ECP including improved endothelial function, decreased inflammation and improved platelet function are responsible for the clinical benefit observed with ECP. Furthermore, we hypothesize that a secondary effect is improved psychological well-being. The overall goal of this study is elucidate the physiological actions of ECP by measuring changes in vascular properties including endothelial function (via brachial artery reactivity to hyperemia), arterial stiffness (via aortic pulse wave velocity) and peripheral vascular health (via ankle brachial index). In addition we will measure hematologic markers of inflammation, the fibrinolytic state, functional studies of platelet aggregation and molecules of endothelial origin. Electrophysiological remodeling of the heart will be assessed using 24 hour Holter monitoring. Psychological well-being will be measured using the SF-36 questionnaire.