{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T17:38:48Z","timestamp":1788197928786,"version":"build-2803163510"},"reference-count":72,"publisher":"Walter de Gruyter GmbH","issue":"1","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Some of the millions of patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have developed new sequelae after recovering from the initial disease, termed post-acute sequelae of coronavirus disease 2019 (PASC). One symptom is anxiety, which is likely due to three etiologies: brain structural changes, neuroendocrine disruption, and neurotransmitter alterations. This review provides an overview of the current literature on the pathophysiological pathways linking coronavirus disease 2019 to anxiety, as well as the possible mechanisms of action in which an increasingly scrutinized treatment method, enhanced external counter-pulsation (EECP), is able to alleviate anxiety. SARS-CoV-2 triggers increased inflammatory cytokine production, as well as oxidative stress; these processes contribute to the aforementioned three etiologies. The potential treatment approach of EECP, involving sequenced inflation and deflation of specifically-placed airbags, has become of increasing interest, as it has been found to alleviate PASC-associated anxiety by improving patient cardiovascular function. These functional improvements were achieved by EECP stimulating anti-inflammatory and pro-angiogenic processes, as well as improving endothelial cell function and coronary blood flow, partially via counteracting against the negative effects of SARS-CoV-2 infection on the renin\u2013angiotensin\u2013aldosterone system. Therefore, EECP could promote both psychosomatic and cardiac rehabilitation. Further research, though, is still needed to fully determine its benefits and mechanism of action.<\/jats:p>","DOI":"10.1515\/med-2024-1067","type":"journal-article","created":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T07:33:58Z","timestamp":1736408038000},"source":"Crossref","is-referenced-by-count":4,"title":["The effects of enhanced external counter-pulsation on post-acute sequelae of COVID-19: A narrative review"],"prefix":"10.1515","volume":"20","author":[{"given":"Jiecheng","family":"Huang","sequence":"first","affiliation":[{"name":"The Second Clinical Medical College, Jinan University , Shenzhen , Guangdong , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuxuan","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Tongji Hospital Affiliated to Tongji University, Tongji University School of Medicine , Shanghai , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongshun","family":"Wang","sequence":"additional","affiliation":[{"name":"The Second Clinical Medical College, Jinan University , Shenzhen , Guangdong , China"},{"name":"Department of Cardiology, Shenzhen People\u2019s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology) , Shenzhen , 518020, Guangdong , China"},{"name":"Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People\u2019s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology) , Shenzhen , Guangdong , China"},{"name":"Shenzhen Key Laboratory of Stem Cell Research and Clinical Transformation, Shenzhen People\u2019s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology) , Shenzhen , Guangdong , China"},{"name":"Department of Geriatrics, Shenzhen People\u2019s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology) , Shenzhen , Guangdong , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingjin","family":"Liu","sequence":"additional","affiliation":[{"name":"The Second Clinical Medical College, Jinan University , Shenzhen , Guangdong , China"},{"name":"Department of Cardiology, Shenzhen People\u2019s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology) , Shenzhen , 518020, Guangdong , China"},{"name":"Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People\u2019s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology) , Shenzhen , Guangdong , China"},{"name":"Shenzhen Key Laboratory of Stem Cell Research and Clinical Transformation, Shenzhen People\u2019s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology) , Shenzhen , Guangdong , China"},{"name":"Department of Geriatrics, Shenzhen People\u2019s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology) , Shenzhen , Guangdong , China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2025,1,9]]},"reference":[{"key":"2025122201303416948_j_med-2024-1067_ref_001","doi-asserted-by":"crossref","unstructured":"Proal AD, VanElzakker MB. Long COVID or post-acute sequelae of COVID-19 (PASC): An overview of biological factors that may contribute to persistent symptoms. Front Microbiol. 2021;12:698169.","DOI":"10.3389\/fmicb.2021.698169"},{"key":"2025122201303416948_j_med-2024-1067_ref_002","doi-asserted-by":"crossref","unstructured":"Ayoubkhani D, Khunti K, Nafilyan V, Maddox T, Humberstone B, Diamond I, et al. Post-covid syndrome in individuals admitted to hospital with covid-19: Retrospective cohort study. BMJ. 2021;372:n693.","DOI":"10.1136\/bmj.n693"},{"key":"2025122201303416948_j_med-2024-1067_ref_003","doi-asserted-by":"crossref","unstructured":"Siddiq MAB, Rasker JJ. COVID-19, long COVID, and psychosomatic manifestations: A possible burden on existing rheumatology facilities. Heart Mind. 2022;6(3):195\u2013202.","DOI":"10.4103\/hm.hm_63_21"},{"key":"2025122201303416948_j_med-2024-1067_ref_004","doi-asserted-by":"crossref","unstructured":"Seighali N, Abdollahi A, Shafiee A, Amini MJ, Teymouri Athar MM, Safari O, et al. The global prevalence of depression, anxiety, and sleep disorder among patients coping with Post COVID-19 syndrome (long COVID): A systematic review and meta-analysis. BMC Psychiatry. 2024;24(1):105.","DOI":"10.1186\/s12888-023-05481-6"},{"key":"2025122201303416948_j_med-2024-1067_ref_005","doi-asserted-by":"crossref","unstructured":"Mazza M, Gaetani E, Marano G, Sani G. Body and mind: Two maps but one territory. mental coaching in support of somatic correlates in times of COVID-19. Heart Mind. 2021;5(4):161\u20132.","DOI":"10.4103\/hm.hm_50_21"},{"key":"2025122201303416948_j_med-2024-1067_ref_006","doi-asserted-by":"crossref","unstructured":"Salari N, Hosseinian-Far A, Jalali R, Vaisi-Raygani A, Rasoulpoor S, Mohammadi M, et al. Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: A systematic review and meta-analysis. Globalization Health. 2020;16(1):57.","DOI":"10.1186\/s12992-020-00589-w"},{"key":"2025122201303416948_j_med-2024-1067_ref_007","unstructured":"COVID-19 Mental Disorders Collaborators. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. Lancet (London, Engl). 2021;398(10312):1700\u201312."},{"key":"2025122201303416948_j_med-2024-1067_ref_008","doi-asserted-by":"crossref","unstructured":"Dryden M, Mudara C, Vika C, Blumberg L, Mayet N, Cohen C, et al. Post-COVID-19 condition 3 months after hospitalisation with SARS-CoV-2 in South Africa: a prospective cohort study. Lancet Global Health. 2022;10(9):e1247\u201356.","DOI":"10.1016\/S2214-109X(22)00286-8"},{"key":"2025122201303416948_j_med-2024-1067_ref_009","doi-asserted-by":"crossref","unstructured":"Sathyamoorthy M, Sevak R, Verduzco-Gutierrez M, Cabrera J, Lopez M, Shah SA. Abstract 14980: Enhanced external counterpulsation improves cognitive function in long covid patients. Circulation. 2022;146(Suppl_1):A14980.","DOI":"10.1161\/circ.146.suppl_1.14980"},{"key":"2025122201303416948_j_med-2024-1067_ref_010","doi-asserted-by":"crossref","unstructured":"Dayrit JK, Verduzco-Gutierrez M, Teal A, Shah SA. Enhanced external counterpulsation as a novel treatment for post-acute COVID-19 sequelae. Cureus. 2021;13(4):e14358.","DOI":"10.7759\/cureus.14358"},{"key":"2025122201303416948_j_med-2024-1067_ref_011","doi-asserted-by":"crossref","unstructured":"Kozdag G, Ertas G, Aygun F, Emre E, Kirbas A, Ural D, et al. Clinical effects of enhanced external counterpulsation treatment in patients with ischemic heart failure. Anadolu Kardiyol Derg. 2012;12(3):214\u201321.","DOI":"10.5152\/akd.2012.064"},{"key":"2025122201303416948_j_med-2024-1067_ref_012","doi-asserted-by":"crossref","unstructured":"Jiang W. Anxiety in individuals with cardiovascular diseases: A narrative review and expert opinion. Heart Mind. 2022;6(2):52\u20137.","DOI":"10.4103\/hm.hm_5_22"},{"key":"2025122201303416948_j_med-2024-1067_ref_013","doi-asserted-by":"crossref","unstructured":"Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A, et al. Neurological associations of COVID-19. Lancet Neurol. 2020;19(9):767\u201383.","DOI":"10.1016\/S1474-4422(20)30221-0"},{"key":"2025122201303416948_j_med-2024-1067_ref_014","doi-asserted-by":"crossref","unstructured":"Bauer L, Laksono BM, de Vrij FMS, Kushner SA, Harschnitz O, van Riel D. The neuroinvasiveness, neurotropism, and neurovirulence of SARS-CoV-2. Trends Neurosci. 2022;45(5):358\u201368.","DOI":"10.1016\/j.tins.2022.02.006"},{"key":"2025122201303416948_j_med-2024-1067_ref_015","doi-asserted-by":"crossref","unstructured":"Besteher B, Machnik M, Troll M, Toepffer A, Zerekidze A, Rocktaschel T, et al. Larger gray matter volumes in neuropsychiatric long-COVID syndrome. Psychiatry Res. 2022;317:114836.","DOI":"10.1016\/j.psychres.2022.114836"},{"key":"2025122201303416948_j_med-2024-1067_ref_016","doi-asserted-by":"crossref","unstructured":"Craske MG, Stein MB. Anxiety. Lancet. 2016;388(10063):3048\u201359.","DOI":"10.1016\/S0140-6736(16)30381-6"},{"key":"2025122201303416948_j_med-2024-1067_ref_017","doi-asserted-by":"crossref","unstructured":"Kamali A, Milosavljevic S, Gandhi A, Lano KR, Shobeiri P, Sherbaf FG, et al. The cortico-limbo-thalamo-cortical circuits: An update to the original papez circuit of the human limbic system. Brain Topogr. 2023;36(3):371\u201389.","DOI":"10.1007\/s10548-023-00955-y"},{"key":"2025122201303416948_j_med-2024-1067_ref_018","doi-asserted-by":"crossref","unstructured":"Brandl F, Weise B, Mulej Bratec S, Jassim N, Hoffmann Ayala D, Bertram T, et al. Common and specific large-scale brain changes in major depressive disorder, anxiety disorders, and chronic pain: a transdiagnostic multimodal meta-analysis of structural and functional MRI studies. Neuropsychopharmacol: Off Publ Am Coll Neuropsychopharmacol. 2022;47(5):1071\u201380.","DOI":"10.1038\/s41386-022-01271-y"},{"key":"2025122201303416948_j_med-2024-1067_ref_019","doi-asserted-by":"crossref","unstructured":"Wang Q, Wang C, Deng Q, Zhan L, Tang Y, Li H, et al. Alterations of regional spontaneous brain activities in anxiety disorders: A meta-analysis. J Affect Disord. 2022;296:233\u201340.","DOI":"10.1016\/j.jad.2021.09.062"},{"key":"2025122201303416948_j_med-2024-1067_ref_020","doi-asserted-by":"crossref","unstructured":"Letko M, Marzi A, Munster V. Functional assessment of cell entry and receptor usage for SARS-CoV-2 and other lineage B betacoronaviruses. Nat Microbiol. 2020;5(4):562\u20139.","DOI":"10.1038\/s41564-020-0688-y"},{"key":"2025122201303416948_j_med-2024-1067_ref_021","doi-asserted-by":"crossref","unstructured":"Devlin L, Gombolay GY. Cerebrospinal fluid cytokines in COVID-19: A review and meta-analysis. J Neurol. 2023;270(11):5155\u201361.","DOI":"10.1007\/s00415-023-11928-3"},{"key":"2025122201303416948_j_med-2024-1067_ref_022","doi-asserted-by":"crossref","unstructured":"Almulla AF, Thipakorn Y, Zhou B, Vojdani A, Maes M. Immune activation and immune-associated neurotoxicity in Long-COVID: A systematic review and meta-analysis of 103 studies comprising 58 cytokines\/chemokines\/growth factors. Brain Behav Immun. 2024;122:75\u201394.","DOI":"10.1016\/j.bbi.2024.07.036"},{"key":"2025122201303416948_j_med-2024-1067_ref_023","doi-asserted-by":"crossref","unstructured":"Tang N, Kido T, Shi J, McCafferty E, Ford JM, Dal Bon K, et al. Blood markers show neural consequences of longCOVID-19. Cells. 2024;13(6):478.","DOI":"10.3390\/cells13060478"},{"key":"2025122201303416948_j_med-2024-1067_ref_024","doi-asserted-by":"crossref","unstructured":"Del Valle DM, Kim-Schulze S, Huang HH, Beckmann ND, Nirenberg S, Wang B, et al. An inflammatory cytokine signature predicts COVID-19 severity and survival. Nat Med. 2020;26(10):1636\u201343.","DOI":"10.1038\/s41591-020-1051-9"},{"key":"2025122201303416948_j_med-2024-1067_ref_025","doi-asserted-by":"crossref","unstructured":"Peluso MJ, Lu S, Tang AF, Durstenfeld MS, Ho HE, Goldberg SA, et al. Markers of immune activation and inflammation in individuals with postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection. J Infect Dis. 2021;224(11):1839\u201348.","DOI":"10.1093\/infdis\/jiab490"},{"key":"2025122201303416948_j_med-2024-1067_ref_026","doi-asserted-by":"crossref","unstructured":"Chen T, Chen H, Chen P, Zhu L, Mao W, Yao Y. High expression of IL6 and decrease in immune cells in COVID-19 patients combined with myocardial injury. Front Immunol. 2023;14:1190644.","DOI":"10.3389\/fimmu.2023.1190644"},{"key":"2025122201303416948_j_med-2024-1067_ref_027","doi-asserted-by":"crossref","unstructured":"Zhou W, Song L, Wang X, Xu Z, Wang S, Wang J, et al. Cardiac injury prediction and lymphocyte immunity and inflammation analysis in hospitalized patients with coronavirus disease 2019 (COVID-19). Int J Cardiol. 2021;326:237\u201342.","DOI":"10.1016\/j.ijcard.2020.10.049"},{"key":"2025122201303416948_j_med-2024-1067_ref_028","doi-asserted-by":"crossref","unstructured":"Giustino G, Croft LB, Stefanini GG, Bragato R, Silbiger JJ, Vicenzi M, et al. Characterization of myocardial injury in patients with COVID-19. J Am Coll Cardiol. 2020;76(18):2043\u201355.","DOI":"10.1016\/j.jacc.2020.08.069"},{"key":"2025122201303416948_j_med-2024-1067_ref_029","doi-asserted-by":"crossref","unstructured":"Pannucci P, Jefferson SR, Hampshire J, Cooper SL, Hill SJ, Woolard J. COVID-19-induced myocarditis: Pathophysiological roles of ACE2 and toll-like receptors. Int J Mol Sci. 2023;24(6):5374.","DOI":"10.3390\/ijms24065374"},{"key":"2025122201303416948_j_med-2024-1067_ref_030","doi-asserted-by":"crossref","unstructured":"Beyerstedt S, Casaro EB, Rangel EB. COVID-19: Angiotensin-converting enzyme 2 (ACE2) expression and tissue susceptibility to SARS-CoV-2 infection. Eur J Clin Microbiol Infect Dis. 2021;40(5):905\u201319.","DOI":"10.1007\/s10096-020-04138-6"},{"key":"2025122201303416948_j_med-2024-1067_ref_031","doi-asserted-by":"crossref","unstructured":"Liu Y, Yang Y, Zhang C, Huang F, Wang F, Yuan J, et al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Sci China Life Sci. 2020;63(3):364\u201374.","DOI":"10.1007\/s11427-020-1643-8"},{"key":"2025122201303416948_j_med-2024-1067_ref_032","doi-asserted-by":"crossref","unstructured":"Lee SH, Fujioka S, Takahashi R, Oe T. Angiotensin II-induced oxidative stress in human endothelial cells: Modification of cellular molecules through lipid peroxidation. Chem Res Toxicol. 2019;32(7):1412\u201322.","DOI":"10.1021\/acs.chemrestox.9b00110"},{"key":"2025122201303416948_j_med-2024-1067_ref_033","doi-asserted-by":"crossref","unstructured":"Coronel PMV, Pereira IC, Basilio D, Espinoca IT, de Souza KFS, Ota RSN, et al. Biomarkers of oxidative stress and inflammation in subjects with COVID-19: Characterization and prognosis of the disease. Microb Pathog. 2023;184:106339.","DOI":"10.1016\/j.micpath.2023.106339"},{"key":"2025122201303416948_j_med-2024-1067_ref_034","doi-asserted-by":"crossref","unstructured":"Al-Hakeim HK, Al-Rubaye HT, Al-Hadrawi DS, Almulla AF, Maes M. Long-COVID post-viral chronic fatigue and affective symptoms are associated with oxidative damage, lowered antioxidant defenses and inflammation: A proof of concept and mechanism study. Mol Psychiatry. 2023;28(2):564\u201378.","DOI":"10.1038\/s41380-022-01836-9"},{"key":"2025122201303416948_j_med-2024-1067_ref_035","doi-asserted-by":"crossref","unstructured":"Michopoulos V, Powers A, Gillespie CF, Ressler KJ, Jovanovic T. Inflammation in fear- and anxiety-based disorders: PTSD, GAD, and Beyond. Neuropsychopharmacology. 2017;42(1):254\u201370.","DOI":"10.1038\/npp.2016.146"},{"key":"2025122201303416948_j_med-2024-1067_ref_036","doi-asserted-by":"crossref","unstructured":"Vogelzangs N, Beekman AT, de Jonge P, Penninx BW. Anxiety disorders and inflammation in a large adult cohort. Transl Psychiatry. 2013;3(4):e249.","DOI":"10.1038\/tp.2013.27"},{"key":"2025122201303416948_j_med-2024-1067_ref_037","doi-asserted-by":"crossref","unstructured":"Vieira MM, Ferreira TB, Pacheco PA, Barros PO, Almeida CR, Araujo-Lima CF, et al. Enhanced Th17 phenotype in individuals with generalized anxiety disorder. J Neuroimmunol. 2010;229(1\u20132):212\u20138.","DOI":"10.1016\/j.jneuroim.2010.07.018"},{"key":"2025122201303416948_j_med-2024-1067_ref_038","doi-asserted-by":"crossref","unstructured":"Russell G, Lightman S. The human stress response. Nat Rev Endocrinol. 2019;15(9):525\u201334.","DOI":"10.1038\/s41574-019-0228-0"},{"key":"2025122201303416948_j_med-2024-1067_ref_039","doi-asserted-by":"crossref","unstructured":"Liu M. Spotlight on the relationship between heart disease and mental stress. Heart Mind. 2021;5(1):1\u20133.","DOI":"10.4103\/hm.hm_12_21"},{"key":"2025122201303416948_j_med-2024-1067_ref_040","doi-asserted-by":"crossref","unstructured":"Felger JC. Imaging the role of inflammation in mood and anxiety-related disorders. Curr Neuropharmacol. 2018;16(5):533\u201358.","DOI":"10.2174\/1570159X15666171123201142"},{"key":"2025122201303416948_j_med-2024-1067_ref_041","doi-asserted-by":"crossref","unstructured":"Miller AH, Haroon E, Raison CL, Felger JC. Cytokine targets in the brain: Impact on neurotransmitters and neurocircuits. Depress Anxiety. 2013;30(4):297\u2013306.","DOI":"10.1002\/da.22084"},{"key":"2025122201303416948_j_med-2024-1067_ref_042","doi-asserted-by":"crossref","unstructured":"Sathyamoorthy M, Sevak RJ, Cabrera J, Lopez M, Fox J, Shah SA, et al. Enhanced external counterpulsation improves cognitive function of persons with long COVID. Am J Phys Med Rehabil. 2024;103(8):734\u20139.","DOI":"10.1097\/PHM.0000000000002433"},{"key":"2025122201303416948_j_med-2024-1067_ref_043","doi-asserted-by":"crossref","unstructured":"Joli J, Buck P, Zipfel S, Stengel A. Post-COVID-19 fatigue: A systematic review. Front Psychiatry. 2022;13:947973.","DOI":"10.3389\/fpsyt.2022.947973"},{"key":"2025122201303416948_j_med-2024-1067_ref_044","doi-asserted-by":"crossref","unstructured":"May O, Lynggaard V, Mortensen JC, Malczynski J. Enhanced external counterpulsation - effect on angina pectoris, QoL and exercise capacity after 1 year. Scand Cardiovasc J. 2015;49(1):1\u20136.","DOI":"10.3109\/14017431.2014.994028"},{"key":"2025122201303416948_j_med-2024-1067_ref_045","doi-asserted-by":"crossref","unstructured":"Sathyamoorthy M, Verduzco-Gutierrez M, Varanasi S, Ward R, Spertus J, Shah S. Enhanced external counterpulsation for management of symptoms associated with long COVID. Am Heart J Plus: Cardiol Res Pract. 2022;13:100105.","DOI":"10.1016\/j.ahjo.2022.100105"},{"key":"2025122201303416948_j_med-2024-1067_ref_046","doi-asserted-by":"crossref","unstructured":"Raza A, Steinberg K, Tartaglia J, Frishman WH, Gupta T. Enhanced external counterpulsation therapy: Past, present, and future. Cardiol Rev. 2017;25(2):59\u201367.","DOI":"10.1097\/CRD.0000000000000122"},{"key":"2025122201303416948_j_med-2024-1067_ref_047","doi-asserted-by":"crossref","unstructured":"Michaels AD, Accad M, Ports TA, Grossman W. Left ventricular systolic unloading and augmentation of intracoronary pressure and Doppler flow during enhanced external counterpulsation. Circulation. 2002;106(10):1237\u201342.","DOI":"10.1161\/01.CIR.0000028336.95629.B0"},{"key":"2025122201303416948_j_med-2024-1067_ref_048","doi-asserted-by":"crossref","unstructured":"Casey DP, Beck DT, Nichols WW, Conti CR, Choi CY, Khuddus MA, et al. Effects of enhanced external counterpulsation on arterial stiffness and myocardial oxygen demand in patients with chronic angina pectoris. Am J Cardiol. 2011;107(10):1466\u201372.","DOI":"10.1016\/j.amjcard.2011.01.021"},{"key":"2025122201303416948_j_med-2024-1067_ref_049","doi-asserted-by":"crossref","unstructured":"Gloekler S, Meier P, de Marchi SF, Rutz T, Traupe T, Rimoldi SF, et al. Coronary collateral growth by external counterpulsation: A randomised controlled trial. Heart. 2010;96(3):202\u20137.","DOI":"10.1136\/hrt.2009.184507"},{"key":"2025122201303416948_j_med-2024-1067_ref_050","doi-asserted-by":"crossref","unstructured":"Wu E, Desta L, Brostrom A, Martensson J. Effectiveness of enhanced external counterpulsation treatment on symptom burden, medication profile, physical capacity, cardiac anxiety, and health-related quality of life in patients with refractory angina pectoris. J Cardiovasc Nurs. 2020;35(4):375\u201385.","DOI":"10.1097\/JCN.0000000000000638"},{"key":"2025122201303416948_j_med-2024-1067_ref_051","doi-asserted-by":"crossref","unstructured":"May O, Sogaard HJ. Enhanced external counterpulsation is an effective treatment for depression in patients with refractory angina pectoris. Prim Care Companion CNS Disord. 2015;17(4):26325.","DOI":"10.4088\/PCC.14m01748"},{"key":"2025122201303416948_j_med-2024-1067_ref_052","doi-asserted-by":"crossref","unstructured":"Davies PF. Hemodynamic shear stress and the endothelium in cardiovascular pathophysiology. Nat Clin Pract Cardiovasc Med. 2009;6(1):16\u201326.","DOI":"10.1038\/ncpcardio1397"},{"key":"2025122201303416948_j_med-2024-1067_ref_053","doi-asserted-by":"crossref","unstructured":"Xu L, Cui M, Zhao W. The effect of EECP on Ischemic Heart Failure: A systematic review. Curr Cardiol Rep. 2023;25(10):1291\u20138.","DOI":"10.1007\/s11886-023-01943-1"},{"key":"2025122201303416948_j_med-2024-1067_ref_054","doi-asserted-by":"crossref","unstructured":"Traub O, Berk BC. Laminar shear stress: Mechanisms by which endothelial cells transduce an atheroprotective force. Arterioscler Thromb Vasc Biol. 1998;18(5):677\u201385.","DOI":"10.1161\/01.ATV.18.5.677"},{"key":"2025122201303416948_j_med-2024-1067_ref_055","doi-asserted-by":"crossref","unstructured":"Zhou J, Li YS, Chien S. Shear stress-initiated signaling and its regulation of endothelial function. Arterioscler Thromb Vasc Biol. 2014;34(10):2191\u20138.","DOI":"10.1161\/ATVBAHA.114.303422"},{"key":"2025122201303416948_j_med-2024-1067_ref_056","doi-asserted-by":"crossref","unstructured":"Casey DP, Conti CR, Nichols WW, Choi CY, Khuddus MA, Braith RW. Effect of enhanced external counterpulsation on inflammatory cytokines and adhesion molecules in patients with angina pectoris and angiographic coronary artery disease. Am J Cardiol. 2008;101(3):300\u20132.","DOI":"10.1016\/j.amjcard.2007.08.031"},{"key":"2025122201303416948_j_med-2024-1067_ref_057","doi-asserted-by":"crossref","unstructured":"Wiese O, Zemlin AE, Pillay TS. Molecules in pathogenesis: Angiotensin converting enzyme 2 (ACE2). J Clin Pathol. 2021;74(5):285\u201390.","DOI":"10.1136\/jclinpath-2020-206954"},{"key":"2025122201303416948_j_med-2024-1067_ref_058","doi-asserted-by":"crossref","unstructured":"Qin X, Deng Y, Wu D, Yu L, Huang R. Does enhanced external counterpulsation (EECP) significantly affect myocardial perfusion?: A systematic review & meta-analysis. PLoS One. 2016;11(4):e0151822.","DOI":"10.1371\/journal.pone.0151822"},{"key":"2025122201303416948_j_med-2024-1067_ref_059","doi-asserted-by":"crossref","unstructured":"Yang H, Song L, Ning X, Ma Y, Xue A, Zhao H, et al. Enhanced external counterpulsation ameliorates endothelial dysfunction and elevates exercise tolerance in patients with coronary artery disease. Front Cardiovasc Med. 2022;9:997109.","DOI":"10.3389\/fcvm.2022.997109"},{"key":"2025122201303416948_j_med-2024-1067_ref_060","doi-asserted-by":"crossref","unstructured":"Beck DT, Martin JS, Casey DP, Avery JC, Sardina PD, Braith RW. Enhanced external counterpulsation improves endothelial function and exercise capacity in patients with ischaemic left ventricular dysfunction. Clin Exp Pharmacol Physiol. 2014;41(9):628\u201336.","DOI":"10.1111\/1440-1681.12263"},{"key":"2025122201303416948_j_med-2024-1067_ref_061","doi-asserted-by":"crossref","unstructured":"Luo C, Liu D, Wu G, Hu C, Zhang Y, Du Z, et al. Effect of enhanced external counterpulsation on coronary slow flow and its relation with endothelial function and inflammation: a mid-term follow-up study. Cardiology. 2012;122(4):260\u20138.","DOI":"10.1159\/000339876"},{"key":"2025122201303416948_j_med-2024-1067_ref_062","doi-asserted-by":"crossref","unstructured":"Zhan Y, Zhang Y, Zhang A, Xiang J. Perceived stress and cardiovascular disease in a community-based population. Heart Mind. 2022;6(4):262\u20136.","DOI":"10.4103\/hm.hm_55_22"},{"key":"2025122201303416948_j_med-2024-1067_ref_063","doi-asserted-by":"crossref","unstructured":"Moser DK, McKinley S, Riegel B, Doering LV, Meischke H, Pelter M, et al. Relationship of persistent symptoms of anxiety to morbidity and mortality outcomes in patients with coronary heart disease. Psychosom Med. 2011;73(9):803\u20139.","DOI":"10.1097\/PSY.0b013e3182364992"},{"key":"2025122201303416948_j_med-2024-1067_ref_064","doi-asserted-by":"crossref","unstructured":"Roest AM, Martens EJ, Denollet J, de Jonge P. Prognostic association of anxiety post myocardial infarction with mortality and new cardiac events: A meta-analysis. Psychosom Med. 2010;72(6):563\u20139.","DOI":"10.1097\/PSY.0b013e3181dbff97"},{"key":"2025122201303416948_j_med-2024-1067_ref_065","doi-asserted-by":"crossref","unstructured":"de Miranda Azevedo R, Roest AM, Hoen PW, de Jonge P. Cognitive\/affective and somatic\/affective symptoms of depression in patients with heart disease and their association with cardiovascular prognosis: A meta-analysis. Psychol Med. 2014;44(13):2689\u2013703.","DOI":"10.1017\/S0033291714000063"},{"key":"2025122201303416948_j_med-2024-1067_ref_066","doi-asserted-by":"crossref","unstructured":"Piva T, Masotti S, Raisi A, Zerbini V, Grazzi G, Mazzoni G, et al. Exercise program for the management of anxiety and depression in adults and elderly subjects: Is it applicable to patients with post-covid-19 condition? A systematic review and meta-analysis. J Affect Disord. 2023;325:273\u201381.","DOI":"10.1016\/j.jad.2022.12.155"},{"key":"2025122201303416948_j_med-2024-1067_ref_067","doi-asserted-by":"crossref","unstructured":"G\u00f3mez L, Vidal B, Cabrera Y, Hern\u00e1ndez L, Rond\u00f3n Y. Successful treatment of post-COVID symptoms with transcranial direct current stimulation. Prim Care Companion CNS Disord. 2021;23(6):21cr03059.","DOI":"10.4088\/PCC.21cr03059"},{"key":"2025122201303416948_j_med-2024-1067_ref_068","doi-asserted-by":"crossref","unstructured":"Hattesohl M, Feistel B, Sievers H, Lehnfeld R, Hegger M, Winterhoff H. Extracts of Valeriana officinalis L. s.l. show anxiolytic and antidepressant effects but neither sedative nor myorelaxant properties. Phytomed: Int J Phytother Phytopharmacol. 2008;15(1\u20132):2\u201315.","DOI":"10.1016\/j.phymed.2007.11.027"},{"key":"2025122201303416948_j_med-2024-1067_ref_069","doi-asserted-by":"crossref","unstructured":"Akhondzadeh S, Naghavi HR, Vazirian M, Shayeganpour A, Rashidi H, Khani M. Passionflower in the treatment of generalized anxiety: a pilot double-blind randomized controlled trial with oxazepam. J Clin Pharm Ther. 2001;26(5):363\u20137.","DOI":"10.1046\/j.1365-2710.2001.00367.x"},{"key":"2025122201303416948_j_med-2024-1067_ref_070","doi-asserted-by":"crossref","unstructured":"Nawrot J, Gornowicz-Porowska J, Budzianowski J, Nowak G, Schroeder G, Kurczewska J. Medicinal herbs in the relief of neurological, cardiovascular, and respiratory symptoms after COVID-19 infection a literature review. Cells. 2022;11(12):1897.","DOI":"10.3390\/cells11121897"},{"key":"2025122201303416948_j_med-2024-1067_ref_071","doi-asserted-by":"crossref","unstructured":"Kasper S, Eckert A, M\u00f6ller HJ, Volz HP, Seifritz E. Psychiatric manifestations of post-COVID-19 syndrome: The potential benefit of Silexan. Int J Psychiatry Clin Pract. 2023;27(3):285\u201391.","DOI":"10.1080\/13651501.2023.2187308"},{"key":"2025122201303416948_j_med-2024-1067_ref_072","doi-asserted-by":"crossref","unstructured":"Santana K, Fran\u00e7a E, Sato J, Silva A, Queiroz M, de Farias J, et al. Non-invasive brain stimulation for fatigue in post-acute sequelae of SARS-CoV-2 (PASC). Brain Stimul. 2023;16(1):100\u20137.","DOI":"10.1016\/j.brs.2023.01.1672"}],"container-title":["Open Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/med-2024-1067\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/med-2024-1067\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T01:30:52Z","timestamp":1766367052000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/med-2024-1067\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,1]]},"references-count":72,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,9]]},"published-print":{"date-parts":[[2025,1,9]]}},"alternative-id":["10.1515\/med-2024-1067"],"URL":"https:\/\/doi.org\/10.1515\/med-2024-1067","relation":{},"ISSN":["2391-5463"],"issn-type":[{"value":"2391-5463","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,1]]},"article-number":"20241067"}}