Enhanced external counterpulsation modulates the heartbeat evoked potential

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.

A study on the immediate effects of enhanced external counterpulsation on physiological coupling

“…As a result, EECP plays a role in protecting the vascular intima and improving endothelial function, which may account for its long-term hemodynamic effects in clinical treatment ( Zhang et al, 2007 ). In addition, while EECP may not change the characteristic parameters of heart rate variability (HRV) that reflect cardiac function during the treatment of ischemic heart disease and angina pectoris ( Michaels et al, 2007 ; Akbarzadeh et al, 2011 ; Liu et al, 2023 ), it can have a significant immediate effect on blood pressure. Moreover, EECP may also exert time-cumulative effects, mainly manifesting as reductions in systolic blood pressure ( Campbell et al, 2008 ; Beck et al, 2015 ; Liang et al, 2021 ).…”