The effect of intra-aortic balloon counterpulsation on left ventricular functional recovery early after acute myocardial infarction: a randomized experimental magnetic resonance imaging study.

AIMS: We sought to determine whether intra-aortic balloon pump (IABP) counterpulsation improves the recovery of left ventricular (LV) systolic function after reperfused acute myocardial infarction (AMI). METHODS AND RESULTS: Fourteen dogs underwent 90-min coronary artery occlusion followed by reperfusion. Seven animals were randomized to IABP counterpulsation immediately after reperfusion. Tagged, cine, and contrast-enhanced magnetic resonance imaging were used for regional and global LV functional assessment and MI characterization, respectively. Image acquisition was performed at 1 h, 6 h, and 24 h after reperfusion, during which the IABP device was paused. Animals randomized to IABP demonstrated an earlier improvement of LV ejection fraction when compared with controls (25+/-3 vs. 25+/-2% at 1 h, P=0.91; 36+/-3 vs. 26+/-2% at 6 h, P=0.015; and 38+/-3 vs. 35+/-1% at 24 h, P=0.34). Regional functional analyses revealed the same behaviour among non-infarcted risk regions, i.e., earlier circumferential systolic strain improvement in the IABP group than in controls (-5.4+/-0.4 vs. -5.3+/-0.5% at 1 h, P=0.86; -12.1+/-1.0 vs. -6.0+/-0.4% at 6 h, P<0.001; and -13.9+/-1.1% vs. -12.8+/-0.6% at 24 h, P=0.40). Importantly, however, the degree of LV functional recovery 24 h after reperfusion was similar whether IABP counterpulsation was used or not. CONCLUSION: IABP counterpulsation accelerates but does not significantly improve the recovery of LV systolic function after reperfused AMI.     

Application of intra-aortic balloon pumping on no-reflow phenomenon in primary PCI for STEMI

background To investigate the effect of intra-aortic balloon pumping (IABP) on no-reflow phenomenon in primary percutaneous coronary intervention (PCI) for ST-Elevation Myocardial Infarction (STEMI). Methods Clinical data of 22 acute myocardial infarction patients after PCI with angiographic no-reflow phenomenon were retrospectively analyzed between January 2006 and December 2009.12 patients underwent IABP, other 10 patients as control group. We observed difference of cardiac structure, brain natriuretic pe...     

The contribution of intramyocardial hemorrhage to the "no-reflow phenomenon": a study performed by cardiac magnetic resonance

Background: Percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) is sometimes complicated by microvascular damage and hemorrhage. Hemoglobin degradation products have magnetic susceptibility effects which help in detecting hemorrhagic AMI by T₂‐weighted cardiac magnetic resonance (CMR) images. Objectives: To investigate the possibility to detect intramyocardial hemorrhage after AMI and to assess its contribution to the delayed hypoenhanced core on late gadolinium enhancement (LGE) CMR, a feature traditionally referred to as microvascular obstruction. Methods: Consecutive patients with AMI who underwent PCI and CMR were investigated. Hypointense zones T₂‐weighted images were labelled as “hemorrhagic” AMI. Areas of late hypoenhancement on LGE CMR were considered as regions of persistent microvascular damage (PMD). Only transmural AMI were considered. Results: A total number of 108 transmural AMI patients were eventually enrolled and divided into two groups according to the presence of hypoenhancement on T₂ images. Thirty‐two patients showed an hypointense stria within the high signal intensity zone on T₂‐weighted images; all these patients showed midmural PMD on LGE. Among the remaining 76 patients, only 14 (18.4%) showed PMD in the subendocardial region. The angiographic outcome was worse in patients with hemorrhagic AMI, with a lower prevalence of TIMI 3 (65.6% vs. 96.1%, P = 0.017) and higher prevalence of myocardial blush grade 0 (84.4% vs. 13.2%, P < 0.001) post‐PCI. Conclusions: T₂‐weighted CMR in reperfused AMI allows identification of hemorrhage, related to PMD areas on LGE images and to a worse reperfusion profile on angiography. These features open new avenues of investigation for prognostic assessment of reperfused AMI. (Echocardiography 2010;27:1120‐1129)     

Stabilisation of medically refractory ventricular arrhythmia by intra-aortic balloon counterpulsation

OBJECTIVE—To review the efficacy of intra-aortic balloon counterpulsation (IABCP) in medically refractory ventricular arrhythmia.
DESIGN—Retrospective analysis of the outcome of patients with ventricular arrhythmia treated with IABCP after transfer between 1992 and 1997.
SETTING—Tertiary cardiac referral centre.
PATIENTS—21 patients (mean age 58 years) who underwent IABCP for control of ventricular arrhythmia. All had significant left ventricular impairment (mean ejection fraction 28.6%); 18 had coronary artery disease.
RESULTS—Before IABCP, 10 patients had incessant monomorphic ventricular tachycardia and 11 had paroxysmal ventricular tachycardia and/or ventricular fibrillation (VT/VF). IABCP resulted in suppression of ventricular arrhythmia in 18 patients, of whom 13 were weaned from IABCP. After stabilisation of ventricular arrhythmia, 10 patients were maintained on medical treatment alone and one underwent endocardial resection. IABCP was maintained until cardiac transplantation in five patients. One patient had a fatal arrest before discharge and one died from progressive heart failure. IABCP failed to control ventricular arrhythmia in three patients and was subsequently discontinued. A cardiac assist device was employed in one of these until cardiac transplantation; the other two were eventually stabilised on medical treatment. Nineteen patients were discharged from hospital. Overall survival was 95% at mean follow up of 25.7 months.
CONCLUSIONS—IABCP can be an effective means of controlling refractory ventricular arrhythmia, allowing time for the institution of more definitive treatment.


Keywords: ventricular arrhythmia; intra-aortic balloon counterpulsation     

主动脉内球囊反搏术治疗心源性休克

目的 回顾性分析主动脉球囊反搏(intra-aortic balloon counterpulsation,IABP)治疗心源性休克的疗效.方法 IABP治疗心源性休克38例,其中急性心肌梗死34例,病毒性心肌炎4例.利用无创血流动力学监测系统(Bioz.com)连续监测患者IABP术前和术后的血流动力学改变.结果 患者心率、平均动脉压、心输出量、顺应指数、左心室做功指数、胸液量、系统血管阻力等血流动力学指标均得到明显改善(P＜0.05),在急性心肌梗死患者34例中,24例行冠状动脉造影术,15例行球囊扩张术及支架植入术,术后死亡7例.5例行冠状动脉旁路移植术,术后死亡2例;治疗组总病死率为9/20(45%).未治疗组14例,死亡12例(12/14,86%);4例病毒性心肌炎死于心源性休克患者3例.结论 IABP能明显改善心源性休克患者的血流动力学指标,对急性心肌梗死合并心源性休克疗效好.     

Clinical significance of intra-aortic balloon pumping on no-reflow phenomenon of primary percutaneous coronary intervention for acute myocardial infarction

Background Percutaneous coronary intervention(PCI) is used as a treatment for acute myocardial infarction(AMI),and one of its major complications is the angiographic no-reflow phenomenon(NR).Although intra-aortic balloon pumping(IABP) is sometimes used in such patients to increase the diastolic coronary blood flow,there is little available information regarding the effects of IABP on the angiographic no-reflow phenomenon.Method Twenty-two AMI patient with NR were performed primary PCI between January 2006 a...     

Current role of intra-aortic diastolic balloon counterpulsation in heart surgery]

Intra-aortic balloon counterpulsation (IABP) is a relatively non-invasive method of circulating assistance, easy to use and which has benefitted from a number of technological improvements in recent years. This retrospective study over 4 years was undertaken to analyse the results of IABP and to determine its role in therapeutic arsenal against cardiac failure. Sixty five patients, 57 coronary and 8 valvular cases, with an average age of 61 +/- 10 years were included. The indications of IABP were: a bridge to transplantation (3 cases), complications of coronary angioplasty (4 cases), and low cardiac output after cardiopulmonary bypass (58 cases), where IABP was curative in 85% of cases and prophylactic in 15% of cases (patients with risk factors of low output state after CPB). Beforehand, 65% of patients had poor left ventricular function (LVEF < 40% and/or CI < 2.2 l/mn/m2). An Aries Medical M700 console was used. The percutaneous femoral approach was feasible in 87% of cases. The results were: improvement with discharge from intensive care unit in 60% of cases, transient improvement in 7% of cases, no improvement in 15% of cases and cardiac transplantation in 8% of cases. The outcome was worse when the preoperative LV function was poor and when high dose inotropic agents had to be used. Survival was 100% in those patients in whom IABP was a prophylactic measure. The average duration of IABP was 72 hours, survival being significantly lower in those in whom IABP was continued for over 3 days. The complications (12.7%) were thromboembolic.(ABSTRACT TRUNCATED AT 250 WORDS)     

Doppler echocardiography evaluation of left ventricular function in intra-aortic balloon counterpulsation

Doppler-echocardiographic measurement of transaortic and mitral flow allows an assessment of systolic and diastolic left ventricular performance. To evaluate the hemodynamic effects of intra-aortic balloon counterpulsation (IABP) 10 patients were examined during IABP after myocardial infarction or cardiothoracic surgery. Doppler echocardiographic transaortic (VAo), early (VE) and late (VA) transmitral flow velocities, transaortic velocity time integral (VTIAo), acceleration and deceleration intervals and rates were obtained. The IABP augmentation was changed from 1:1, 1:2 to 1:4 causing no notable change in invasively measured arterial pressures (p greater than 0.05). With constant heart rate the VE/VA ratio was similar in 1:2 and 1:1 mode (1.44 +/- 0.42 vs 1.47 +/- 0.27; p greater than 0.2), whereas VAo and VTIAo were increased (p less than 0.01). A beat-to-beat analysis during 1:2 mode confirmed an increase in VAo (84.1 +/- 13.5 vs 98.3 +/- 16.5 cm/s; p less than 0.01) and VTIAo after the augmenting balloon inflation, but did not confirm any concomitant effect on diastolic transmitral parameters; acceleration and deceleration intervals were not changed. Thus, Doppler-echocardiography was able to detect an increase in transaortic flow during IABP augmentation by beat-to-beat analysis. The increase in VTIAo indicates an elevated cardiac output. A similar instantaneous effect on the diastolic transmitral flow could not be identified.     

主动脉内球囊反搏患者P-选择素与血小板减少症的相关性研究

通过观察主动脉内球囊反搏(IABP)置入前后血浆P-选择素的变化规律,探讨P-选择素与IABP相关血小板减少症发生与发展的关系。方法:选择安贞医院首次放置IABP辅助治疗患者40例。分别于其放置IABP前,放置IABP后12 h、24 h、48 h和72 h,抽取肘正中静脉血样,用酶联免疫吸附实验(ELISA)方法测定血浆P-选择素的浓度。分析IABP放置72 h内血浆P-选择素浓度的变化趋势。根据围手术期期间IABP放置时段的不同,将样本分为3组,分别为术前放置组、术中放置组及术后放置组,分析不同时点放置IABP对血小板活化的影响。结果:对40例患者进行的临床试验研究显示,IABP放置前后血浆P-选择素浓度的差异有统计学意义(P<0.05)。患者血浆中P-选择素的浓度在IABP放置后即开始升高,并于放置后48 h达到峰值,其后开始逐步下降。术前放置IABP、术中放置IABP和术后放置IABP,组间血浆P-选择素的浓度的差异无统计学意义(P>0.05)。结论:IABP置入后血浆P-选择素浓度表达升高,血小板活化程度增强,血小板破坏消耗增多,导致血小板计数减少。     

Effect of intra-aortic balloon counterpulsation on the motion and perfusion of acutely ischemic myocardium. An experimental echocardiographic study.

The effect of intra-aortic balloon counterpulsation (IABC) on the motion and perfusion of ischemic left ventricular posterior myocardium was studied in 30 open-chest dogs, using ultrasound to register motion and 7-10 mu radioactive microspheres to determine perfusion. Circumflex coronary artery ligation produced acute aneurysmal bulging during isovolumetric contraction and diminished ischemic wall velocity during systolic ejection. Myocardial perfusion was determined in five dogs; perfusion of the area supplied by the ligated coronary artery fell from a control value of 72.9 +/- 13.8 (SE) to 30.0 +/- 2.3 cc/100 g/min (P less than 0.05) at 5 minutes after coronary occlusion. IABC was then administered for one hour, with a fall in aortic systolic pressure (112 +/- 6 to 105 +/- 7 mm Hg, P less than 0.05) and rise in peak aortic diastolic pressure (94 +/- 6 to 102 +/- 7 mm Hg, P less than 0.05). Despite this the ischemic area showed no change in perfusion (measured at the same time): 30.0 +/- 2.3 to 28.0 +/- 2.4 cc/100 g/min. Little change in wall motion occurred: aneurysmal bulging decreased modestly (4.5 +/- 0.3 to 3.6 +/- 0.3 mm, P less than 0.05), but ischemic wall velocity did not increase. After cessation of counterpulsation and one hour of coronary reperfusion aneurysmal bulging disappeared and wall velocity improved. The addition of norepinephrine (eight dogs) or nitroprusside (seven dogs) to intraaortic balloon counterpulsation did not cause a significant further improvement in the response of the dyskinesis during the period of ischemia. We conclude that IABC has little effect on ischemic dyskinesis, probably due to its failure to improve perfusion of the acutely ischemic myocardium.     

Characteristic of patients surviving over a long-term period after intra-aortic balloon counterpulsation treatment

Control examination of 21 patients after cardiac surgery which required the application of intra-aortic balloon counterpulsation in order to terminate extracorporeal circulation showed that, in spite of the serious postoperative course, the prognosis and quality of their life is a good one. Objective signs of left ventricular function show rather a moderate deterioration. Patients after myocardial revascularization have at the same time a demonstrable ischaemic disease of the lower extremities. Changes of more serious nature on the arteries of the lower extremities in connection with the earlier application of intra-aortic balloon counterpulsation could not be documented.     

Impact of intra-aortic balloon counterpulsation with different balloon volumes on cardiac performance in humans.

Intra-aortic balloon (IAB) counterpulsation can augment the cardiac output. However, the effect of different IAB volumes on cardiac performance has not been adequately evaluated in humans. Eighty-two patients (52 males [63%]; mean age, 65 +/- 12 years; mean body surface area [BSA], 1.8 +/- 0.2 m(2)) had IAB counterpulsation for cardiogenic shock, refractory angina, and preoperatively for high-risk cardiac surgery. Cardiac hemodynamics were prospectively studied during IAB with inflation volumes of 32 vs. 40 cc. Hemodynamic data collected included aortic pressure, pulmonary artery pressure, systemic and mixed venous oxygen saturations, and cardiac output (by Fick). Transthoracic echocardiography (TTE) was used to obtain both velocity time integrals (VTIs) and the area of the left ventricular outflow tract (LVOT). Left ventricular stroke volume was then calculated as LVOT area x VTI. Cardiac output (CO) determined by the Fick method and VTI did not differ significantly (P = NS) between the two inflation volumes (y = 0.002 + 0.97x). In a subgroup of 33 patients with BSA 相似文献   

主动脉内球囊反搏术在急性心肌梗死治疗中的应用和对近期预后的影响

目的了解急性心肌梗死（AMI）治疗中主动脉内球囊反搏术（IABP）的应用、并发症发生率和对近期预后的影响。方法单中心注册研究。连续入选2004年10月至2008年7月间,就诊于北京安贞医院28病房置入IABP的所有AMI患者。结果806例AMI患者中,共有121例（15.0%）置入IABP。最常见指征为高危冠状动脉（冠脉）造影和（或）PCI术中和术后提供血流动力学支持（66.9%）和心源性休克（26.4%）。IABP置入成功率为98.3%,平均使用时间为34±16h。严重并发症发生率为0%。所有患者均进行了冠脉造影,93.4%在出院前施行了冠脉血管重建。总住院死亡率为13.2%（其中心源性休克患者34.4%）,住院死亡率因置入IABP指征不同和施行冠脉血管重建与否存在很大差异。结论IABP可成功应用于AMI的多种高危状况并提供必要的血流动力学支持,严重并发症罕见,联合冠脉血管重建治疗可降低死亡率。     

Augmentation of regional coronary blood flow by intra-aortic balloon counterpulsation in patients with unstable angina

Intra-aortic balloon counterpulsation is capable of reducing afterload in patients with unstable angina. Whether it is also capable of augmenting coronary blood flow to poststenotic myocardium is controversial. We studied seven patients receiving maximal drug therapy and requiring balloon pumping for unstable angina as balloon volume and assist ratio were altered. All patients had greater than 90% stenosis of the proximal left anterior descending coronary artery. With maximal augmentation (40 cc balloon volume, 1:1 assist ratio) great cardiac vein flow, representing the efflux from the left anterior descending coronary artery bed, rose from a baseline of 52 +/- 20 to 67 +/- 25 ml/min (mean +/- SD, p = .004) and mean aortic diastolic pressure increased from 77 +/- 13 to 99 +/- 33 mm Hg (p = .004). Increased great cardiac vein flow correlated with increased mean aortic diastolic pressure across changes in balloon volumes (off, 20 cc, 30 cc, and 40 cc) and changes in assist ratio (off, 1:4, 1:2, and 1:1) (p = .02). However, the intermediate balloon volumes produced great cardiac vein flows at an intermediate level between full assist and no assist (p less than .05), whereas the intermediate assist ratios did not augment flow. Thus balloon pumping increased flow to a bed fed by collateral vessels or critical stenoses; this increased flow correlated with increased aortic diastolic pressure, indicating probable loss of autoregulatory ability.     

Evaluation of balloon angioplasty of coarctation restenosis by magnetic resonance imaging

Eight patients treated by balloon angioplasty for coarctation restenosis have been followed for 4 to 54 months (mean 40) by physical examination using Doppler pressures and by magnetic resonance imaging in a superconducting magnet operating at 0.6 tesla. Image analysis was performed by inspection and by measurement of the aorta, with particular attention to the angioplasty site and its relation to the ascending aorta at the same axial level. Similar measurements were made from immediate postangioplasty angiograms. Residual pressure gradients were 0 to 12 mm (mean 2), reflecting persistent absence of a gradient in 1 patient and further gradient reduction in 7. Images showed no aneurysm formation, mild residual or recurrent stenosis in 4 patients, minimal focal periaortic soft tissue thickening in 1 patient and an interval increase in the ratio of ballooned segment diameter to ascending aortic diameter in the 7 patients in whom it could be measured. Thus, intermediate-term results of balloon dilatation of coarctation restenosis are excellent and magnetic resonance imaging is well suited to the serial studies required in these patients.     

The role of intra-aortic balloon counterpulsation in patients undergoing percutaneous transluminal coronary angioplasty

Between June, 1979, and July, 1982, 14 patients required an IABP in conjunction with PTCA. The clinical indications for balloon counterpulsation, in the performance of PTCA were (1) clinically unstable situations where PTCA might otherwise be contraindicated, e.g., left main stem disease, multivessel coronary artery disease, unstable anginal syndromes, and cardiogenic shock; (2) preoperative insertion of an IABP for added safety following unsuccessful angioplasty; (3) abrupt vessel closure during a PTCA procedure in which the patient becomes hemodynamically unstable; and (4) late vessel closure following an initially successful angioplasty resulting in hemodynamic compromise. Of the 14 cases requiring balloon counterpulsation, 13 survived hospitalization and were alive at the time this report was submitted. We conclude that IABP is a useful adjunct to PTCA in a variety of clinical circumstances.