J Clin Neurol.  2016 Jul;12(3):308-315. 10.3988/jcn.2016.12.3.308.

External Counterpulsation Reduces Beat-to-Beat Blood Pressure Variability When Augmenting Blood Pressure and Cerebral Blood Flow in Ischemic Stroke

• Tian G
• Xiong L
• Lin W
• Han J
• Chen X
• Leung TW
• Soo YO
• Wong LK

• KMID: 2354118
• DOI: http://doi.org/10.3988/jcn.2016.12.3.308

Abstract

BACKGROUND AND PURPOSE
External counterpulsation (ECP) is a noninvasive method used to enhance cerebral perfusion by elevating the blood pressure in ischemic stroke. However, the response of the beat-to-beat blood pressure variability (BPV) in ischemic stroke patients during ECP remains unknown.
METHODS
We enrolled recent ischemic stroke patients and healthy controls. Changes in the blood flow velocities in bilateral middle cerebral arteries and the continuous beat-to-beat blood pressure before, during, and after ECP were monitored. Power spectral analysis revealed that the BPV included oscillations at very low frequency (VLF; <0.04 Hz), low frequency (LF; 0.04-0.15 Hz), and high frequency (HF; 0.15-0.40 Hz), and the total power spectral density (TP; <0.40 Hz) and LF/HF ratio were calculated.
RESULTS
We found that ECP significantly increased the systolic and diastolic blood pressures in both stroke patients and controls. ECP decreased markedly the systolic and diastolic BPVs at VLF and LF and the TP, and the diastolic BPV at HF when compared with baseline. The decreases in diastolic and systolic BPV reached 37.56% and 23.20%, respectively, at VLF, 21.15% and 12.19% at LF, 8.76% and 16.59% at HF, and 31.92% and 23.62% for the total TP in stroke patients, which did not differ from those in healthy controls. The change in flow velocity on the contralateral side was positively correlated with the total TP systolic BPV change induced by ECP (r=0.312, p=0.035).
CONCLUSIONS
ECP reduces the beat-to-beat BPV when increasing the blood pressure and cerebral blood flow velocity in ischemic stroke patients. ECP might be able to improve the clinical outcome by decreasing the beat-to-beat BPV in stroke patients, and this should be explored further in future studies.

Keyword

blood pressure; blood pressure variability; cerebral hemodynamics; external counterpulsation; ischemic stroke

MeSH Terms

Blood Flow Velocity
Blood Pressure*
Cerebrovascular Circulation*
Counterpulsation*
Humans
Methods
Middle Cerebral Artery
Perfusion
Stroke*

Figure

• 

  Fig. 1 Correlation between CAI and BPV changes during ECP from baseline. A: Correlation between CAI on the ipsilateral side and the percentage decrease in the HF DBP during ECP from baseline. B: Correlation between CAI on the contralateral side and the percentage decrease in TP of the SBP during ECP from baseline. C: Correlation between CAI on the contralateral side and the percentage decrease in LF/HF of the SBP during ECP from baseline. CAI: cerebral augmentation index, DBP: diastolic blood pressure, ECP: external counterpulsation, HF: high frequency, LF: low frequency, SBP: systolic blood pressure.

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