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Baldetti L, Pagnesi M, Gramegna M, Belletti A, Beneduce A, Pazzanese V, Calvo F, Sacchi S, Van Mieghem NM, den Uil CA, Metra M, Cappelletti AM. Intra-Aortic Balloon Pumping in Acute Decompensated Heart Failure With Hypoperfusion: From Pathophysiology to Clinical Practice. Circ Heart Fail 2021; 14:e008527. [PMID: 34706550 DOI: 10.1161/circheartfailure.121.008527] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Trials on intra-aortic balloon pump (IABP) use in cardiogenic shock related to acute myocardial infarction have shown disappointing results. The role of IABP in cardiogenic shock treatment remains unclear, and new (potentially more potent) mechanical circulatory supports with arguably larger device profile are emerging. A reappraisal of the physiological premises of intra-aortic counterpulsation may underpin the rationale to maintain IABP as a valuable therapeutic option for patients with acute decompensated heart failure and tissue hypoperfusion. Several pathophysiological features differ between myocardial infarction- and acute decompensated heart failure-related hypoperfusion, encompassing cardiogenic shock severity, filling status, systemic vascular resistances rise, and adaptation to chronic (if preexisting) left ventricular dysfunction. IABP combines a more substantial effect on left ventricular afterload with a modest increase in cardiac output and would therefore be most suitable in clinical scenarios characterized by a disproportionate increase in afterload without profound hemodynamic compromise. The acute decompensated heart failure syndrome is characterized by exquisite afterload-sensitivity of cardiac output and may be an ideal setting for counterpulsation. Several hemodynamic variables have been shown to predict response to IABP within this scenario, potentially guiding appropriate patient selection. Finally, acute decompensated heart failure with hypoperfusion may frequently represent an end stage in the heart failure history: IABP may provide sufficient hemodynamic support and prompt end-organ function recovery in view of more definitive heart replacement therapies while preserving ambulation when used with a transaxillary approach.
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Affiliation(s)
- Luca Baldetti
- IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., M.G., V.P., F.C., S.S., A.M.C.)
| | - Matteo Pagnesi
- Department of Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy (M.P., M.M.)
| | - Mario Gramegna
- IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., M.G., V.P., F.C., S.S., A.M.C.)
| | - Alessandro Belletti
- Cardiac Intensive Care Unit, Department of Anesthesia and Intensive Care (A. Belletti)
| | | | - Vittorio Pazzanese
- IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., M.G., V.P., F.C., S.S., A.M.C.)
| | - Francesco Calvo
- IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., M.G., V.P., F.C., S.S., A.M.C.)
| | - Stefania Sacchi
- IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., M.G., V.P., F.C., S.S., A.M.C.)
| | - Nicolas M Van Mieghem
- Department of Cardiology and Intensive Care Medicine, Thoraxcenter, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (N.M.V.M., C.A.d.U.)
| | - Corstiaan A den Uil
- Department of Cardiology and Intensive Care Medicine, Thoraxcenter, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (N.M.V.M., C.A.d.U.).,Department of Intensive Care Medicine, Maasstad Hospital, Rotterdam, the Netherlands (C.A.d.U.)
| | - Marco Metra
- Department of Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy (M.P., M.M.)
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Intraaortic Balloon Pump Counterpulsation, Part I: History, Technical Aspects, Physiologic Effects, Contraindications, Medical Applications/Outcomes. Anesth Analg 2020; 131:776-791. [DOI: 10.1213/ane.0000000000004954] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Papaioannou T, Lekakis J, Dagre A, Stamatelopoulos K, Terrovitis J, Gialafos E, Kanakakis J, Nanas J, Stamatelopoulos S, Moulopoulos S. Arterial Compliance is an Independent Factor Predicting Acute Hemodynamic Performance of Intra-aortic Balloon Counterpulsation. Int J Artif Organs 2018. [DOI: 10.1177/039139880102400710] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Data concerning the effect of arterial compliance (AC) on hemodynamics during intra-aortic balloon counterpulsation (IABC) are lacking. This study examines the effect of AC on acute hemodynamics induced by IABC in 15 patients with post-infarction cardiogenic shock. AC was estimated by aortic pulse wave analysis using the reflection time index (RTI). Measurements were obtained once per day during IABC. The % reduction in systolic aortic pressure (ΔSAP), end-diastolic aortic pressure (ΔEDAP) and the peak aortic diastolic augmentation (PADA) were used as performance indices of IABC; 107 sets of measurements were obtained. Multivariate analysis indicated an independent association of each IABC performance index with AC (p<0.05). A high AC group (RTI≤20.6%, n=40) and a low AC group (RTI>20.6%, n=67) were obtained. ΔSAP, ΔEDAP and PADA were significantly higher in the low AC group by almost 75%, 54.6% and 11,3% (p<0.03), while arterial blood pressure did not significantly differ. Arterial compliance is an independent factor affecting hemodynamics during IABC. RTI values higher than 20.6% may predict a better acute hemodynamic response to IABC.
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Affiliation(s)
- T.G. Papaioannou
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, Athens University, Athens - Greece
| | - J.P. Lekakis
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, Athens University, Athens - Greece
| | - A.G. Dagre
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, Athens University, Athens - Greece
| | - K.S. Stamatelopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, Athens University, Athens - Greece
| | - J. Terrovitis
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, Athens University, Athens - Greece
| | - E.J. Gialafos
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, Athens University, Athens - Greece
| | - J. Kanakakis
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, Athens University, Athens - Greece
| | - J. Nanas
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, Athens University, Athens - Greece
| | - S.F. Stamatelopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, Athens University, Athens - Greece
| | - S. Moulopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, Athens University, Athens - Greece
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Fischer EIC, Bia D, ZÓCalo Y, Armentano RL. Smooth Muscle-Dependent Changes in Aortic Wall Dynamics during Intra-Aortic Counterpulsation in an Animal Model of Acute Heart Failure. Int J Artif Organs 2018; 32:354-61. [DOI: 10.1177/039139880903200606] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Intra-aortic balloon pumping (IABP) may modify arterial biomechanics; however, its effects on arterial wall properties during acute cardio-depression have not yet been fully explored. This dynamical study was designed to characterize the effects of IABP on aortic wall mechanics in an in vivo animal model of acute heart failure. Methods Aortic pressure, diameter and blood flow were measured in six anesthetized sheep with acute cardio-depression by halothane (4%), before and during IABP (1:2). Aortic characteristic impedance and aortic wall stiffness indexes were calculated. Results Acute experimental cardio-depression resulted in a reduction in mean aortic pressure (p<0.05) and an increase in the characteristic impedance (p<0.005), incremental elastic modulus (p<0.05), stiffness index (p<0.05) and Peterson elastic modulus (p<0.05). IABP caused an increase in the cardiac output (p<0.005) and a reduction in the systemic vascular resistances (p<0.05). In addition, the aortic impedance, incremental elastic modulus, stiffness index and Peterson modulus were significantly reduced during IABP (p<0.05). Conclusions Our findings show that IABP caused changes in aortic wall impedance and intrinsic wall properties, improving the arterial functional capability and the left ventricular afterload by a reduction in both. Systemic vascular resistances and aortic stiffness were also improved by means of smooth muscle-dependent mechanisms.
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Affiliation(s)
- Edmundo I. Cabrera Fischer
- Basic Sciences Research Institute & FICEN-Favaloro University, Buenos Aires - Argentina
- Member of the National Council of Scientific and Technical Research (CONICET), Buenos Aires - Argentina
| | - Daniel Bia
- Physiology Department, School of Medicine, Republic University, Montevideo - Uruguay
| | - Yanina ZÓCalo
- Physiology Department, School of Medicine, Republic University, Montevideo - Uruguay
| | - Ricardo L. Armentano
- Basic Sciences Research Institute & FICEN-Favaloro University, Buenos Aires - Argentina
- Physiology Department, School of Medicine, Republic University, Montevideo - Uruguay
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Sintek MA, Gdowski M, Lindman BR, Nassif M, Lavine KJ, Novak E, Bach RG, Silvestry SC, Mann DL, Joseph SM. Intra-Aortic Balloon Counterpulsation in Patients With Chronic Heart Failure and Cardiogenic Shock: Clinical Response and Predictors of Stabilization. J Card Fail 2015; 21:868-76. [PMID: 26164215 DOI: 10.1016/j.cardfail.2015.06.383] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 06/19/2015] [Accepted: 06/29/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this work was to characterize the clinical response and identify predictors of clinical stabilization after intra-aortic balloon counterpulsation (IABP) support in patients with chronic systolic heart failure in cardiogenic shock before implantation of a left ventricular assist device (LVAD). BACKGROUND Limited data exist regarding the clinical response to IABP in patients with chronic heart failure in cardiogenic shock. METHODS We identified 54 patients supported with IABP before LVAD implantation. Criteria for clinical decompensation after IABP insertion and before LVAD included the need for more advanced temporary support, initiation of mechanical ventilation or dialysis, increase in vasopressors/inotropes, refractory ventricular arrhythmias, or worsening acidosis. The absence of these indicated stabilization. RESULTS Clinical decompensation after IABP occurred in 23 patients (43%). Both patients who decompensated and those who stabilized had similar hemodynamic improvements after IABP support, but patients who decompensated required more vasopressors/inotropes. Clinical decompensation after IABP was associated with worse outcomes after LVAD implantation, including a 3-fold longer intensive care unit stay and 5-fold longer time on mechanical ventilation (P < .01 for both). Although baseline characteristics were similar between groups, right and left ventricular cardiac power indexes (cardiac power index = cardiac index × mean arterial pressure/451) identified patients who were likely to stabilize (area under the receiver operating characteristic curve = 0.82). CONCLUSIONS Among patients with chronic systolic heart failure who develop cardiogenic shock, more than one-half of patients stabilized with IABP support as a bridge to LVAD. Baseline measures of right and left ventricular cardiac power, reflecting work performed for a given flow and pressure, may allow clinicians to identify patients with sufficient contractile reserve who will be likely to stabilize with an IABP versus those who may need more aggressive ventricular support.
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Affiliation(s)
- Marc A Sintek
- Cardiovascular Division, Washington University School of Medicine, St Louis, Missouri
| | - Mark Gdowski
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Brian R Lindman
- Cardiovascular Division, Washington University School of Medicine, St Louis, Missouri
| | - Michael Nassif
- Cardiovascular Division, Washington University School of Medicine, St Louis, Missouri
| | - Kory J Lavine
- Cardiovascular Division, Washington University School of Medicine, St Louis, Missouri
| | - Eric Novak
- Cardiovascular Division, Washington University School of Medicine, St Louis, Missouri
| | - Richard G Bach
- Cardiovascular Division, Washington University School of Medicine, St Louis, Missouri
| | | | - Douglas L Mann
- Cardiovascular Division, Washington University School of Medicine, St Louis, Missouri
| | - Susan M Joseph
- Cardiovascular Division, Washington University School of Medicine, St Louis, Missouri.
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Onorati F, Santini F, Amoncelli E, Campanella F, Chiominto B, Faggian G, Mazzucco A. How should I wean my next intra-aortic balloon pump? Differences between progressive volume weaning and rate weaning. J Thorac Cardiovasc Surg 2013; 145:1214-21. [DOI: 10.1016/j.jtcvs.2012.03.063] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 03/14/2012] [Accepted: 03/22/2012] [Indexed: 11/26/2022]
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Gelsomino S, Renzulli A, Rubino AS, Romano SM, Luca F, Valente S, Gensini GF, Lorusso R. Effects of 1:1, 1:2 or 1:3 intra-aortic balloon counterpulsation/heart support on coronary haemodynamics and cardiac contractile efficiency in an animal model of myocardial ischaemia/reperfusion. Eur J Cardiothorac Surg 2012; 42:325-332. [DOI: 10.1093/ejcts/ezr327] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
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Bia D, Cabrera-Fischer EI, Zócalo Y, Armentano RL. Intra-aortic balloon pumping reduces the increased arterial load caused by acute cardiac depression, modifying central and peripheral load determinants in a time- and flow-related way. Heart Vessels 2011; 27:517-27. [DOI: 10.1007/s00380-011-0203-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 09/30/2011] [Indexed: 11/24/2022]
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Bia D, Cabrera-Fischer EI, Zócalo Y, Armentano RL. The endothelium modulates the arterial wall mechanical response to intra-aortic balloon counterpulsation: in vivo studies. Artif Organs 2011; 35:883-92. [PMID: 21848928 DOI: 10.1111/j.1525-1594.2011.01320.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Intra-aortic balloon pump (IABP) benefits could depend on variations in the cardiovascular biomechanical properties associated with blood flow-induced endothelium-dependent changes. However, if IABP results in changes in the peripheral artery biomechanics and if the endothelium plays a role in these potential changes remains unknown. The aim of this study is to characterize acute IABP effects on peripheral artery biomechanics in control and acute heart failure (AHF) states and the role of the endothelium in IABP effects on peripheral artery biomechanics. Pressure and diameter were recorded in sheep (n= 7) iliac arteries (IAs), before and during 1:2 IABP, during four states: (i) control with intact IA; (ii) AHF with intact IA; (iii) control with de-endothelialized (DE) (mechanical rubbing) IA; and (iv) AHF with DE IA. Arterial distensibility, elastic modulus, and conduit function (CF) (1/characteristic impedance) were calculated. The results of this study include: (i) during control conditions, IABP resulted in intact IA dilatation, stiffness reduction, and CF increase; (ii) AHF induction determined a reduction in intact IA diameter and CF, and a stiffness increase. These changes reverted during IABP; (iii) the increase in IA stiffness observed after DE remained unchanged during IABP; (iv) in DE IA, AHF did not result in diameter or stiffness changes; and (v) IABP during AHF did not associate changes in diameter or stiffness in the DE IA. In conclusion, during control and AHF states, IABP results in IA dilatation and stiffness reduction. The integrity of the endothelial layer would be critical for the IABP-associated changes in IA biomechanics.
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Affiliation(s)
- Daniel Bia
- Cardiovascular Hemodynamic Group, Physiology Department, School of Medicine, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial, Republic University, Montevideo, Uruguay.
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Bia D, Zócalo Y, Armentano R, Camus J, Forteza ED, Cabrera-Fischer E. Increased reversal and oscillatory shear stress cause smooth muscle contraction-dependent changes in sheep aortic dynamics: role in aortic balloon pump circulatory support. Acta Physiol (Oxf) 2008; 192:487-503. [PMID: 17973954 DOI: 10.1111/j.1748-1716.2007.01765.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS The intra-aortic balloon pumping (IABP) changes pressure and increases the aorta shear stress reversal (SS(R)) and oscillatory (SS(O)) components. Hence, IABP-dependent changes in aortic biomechanics would be expected, because of vascular smooth muscle (VSM) tone (i.e. flow-induced endothelium-dependent response, related to SS(R) and SS(O) variations) and/or pressure changes. To characterize: (i) the IABP effects on the aortic and global (systemic circulation) biomechanics, analysing their dependence on pressure and VSM basic tone changes and (ii) the relation between the SS(R) and SS(O) and the aortic biomechanical changes associated with the VSM tone variations. METHODS Aortic flow, pressure and diameter were measured in eight sheep during basal, augmented and assisted beats (1 : 1 and 1 : 2 IABP modalities). Calculations: (i) aortic effective and isobaric elasticity, viscosity, circumferential stress, pulse wave velocity, shear stress and buffer and conduit functions, (ii) peripheral resistance, global compliance, reflection coefficient and wave propagation times and (iii) the relation between SS(R) and SS(O) and biomechanical changes associated with variations in the aortic VSM tone. RESULTS Augmented and assisted beats showed: global VSM relaxation pattern (reduced peripheral resistance and reflection coefficient; increased propagation times) and local VSM contraction pattern (increased viscosity; reduced diameter, elasticity and circumferential stress), associated with SS(R) and SS(O), levels and changes. The vascular changes reduced the ventricle afterload determinants, increased the vascular buffer performance and kept the conduit capability. CONCLUSION In addition to pressure-dependent changes, IABP determined biomechanical changes related to variations in the VSM tone. The increased SS(R) and SS(O) were associated with the aortic VSM contraction pattern and biomechanical changes.
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Affiliation(s)
- D Bia
- Physiology Department, School of Medicine, Republic University, Montevideo, Uruguay.
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Effects of Intra-Aortic Counterpulsation on Aortic Wall Energetics and Damping: In Vivo Experiments. ASAIO J 2008; 54:44-9. [DOI: 10.1097/mat.0b013e3181611c18] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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12
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Dekker ALAJ, Reesink KD, van der Veen FH, van Ommen GVA, Geskes GG, Soemers ACM, Maessen JG. Intra-aortic balloon pumping in acute mitral regurgitation reduces aortic impedance and regurgitant fraction. Shock 2003; 19:334-8. [PMID: 12688544 DOI: 10.1097/00024382-200304000-00007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Acute mitral regurgitation (MR) is present in 10% of patients presenting with cardiogenic shock. To stabilize these patients, intra-aortic balloon pumping (IABP) is recommended, but the mechanism of IABP support in these patients is unknown. This animal study was designed to describe the hemodynamic effect of intra-aortic balloon pumping during cardiogenic shock induced by acute MR. In eight calves, left ventricular pressure-volume loops, aortic and left atrial pressure, and aortic, carotid artery, and coronary blood flow were recorded. Acute MR (range 36%-79%) was created by placing a metal cage in the mitral valve. Hemodynamic data was obtained at control, during acute MR, and during acute MR with 1:1 IABP support. Acute MR caused a decrease in cardiac output (-32%, P = 0.018), blood pressure, and carotid artery flow, whereas left ventricular output (+127%, P = 0.018), end-diastolic volume, and left atrial pressure all significantly increased. Stroke work, ejection fraction, and coronary blood flow were not significantly changed, and no signs of ischemia were seen on the ECG. The IABP raised average cardiac output by 31% (P = 0.012) and significantly raised blood pressure and flow to the brain while decreasing systemic vascular resistance. Left ventricular function and mean coronary blood flow did not change, but diastolic coronary flow became more important as shown by the increase in diastolic fraction from 64% to 95%. (P = 0.028). Average MR dropped by 7.5% (P = 0.025). In conclusion, application of the IABP during acute MR lowers aortic impedance, resulting in less MR and more output toward the aorta without changing left ventricular function.
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Affiliation(s)
- André L A J Dekker
- Departments of Cardio Thoracic Surgery and Cardiology, Cardiovascular Research Institute Maastricht, Academic Hospital, Maastricht, The Netherlands
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Abstract
Because of its elastic properties, the aorta influences left ventricular function and coronary blood flow. The aortic pressure-diameter relationship provides direct estimations of the elastic properties of the aorta in humans. Current research is focused on examining strategies that might improve aortic function. Therapeutic interventions alter the elastic properties of the aorta, and improvement of the elastic properties of the aorta may be beneficial in modifying the natural history of the disease. Certain pharmacological agents that result in improved aortic function have been identified.
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Affiliation(s)
- P Toutouzas
- Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece
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Kawaguchi O, Pae WE, Daily BB, Pierce WS. Ventriculoarterial coupling with intra-aortic balloon pump in acute ischemic heart failure. J Thorac Cardiovasc Surg 1999; 117:164-71. [PMID: 9869771 DOI: 10.1016/s0022-5223(99)70482-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE We analyzed the mechanism of effects of intra-aortic balloon pumping using the pressure-volume relationship and ventriculoarterial coupling in the normal and failing hearts. MATERIALS In 12 anesthetized Holstein calves (weight, 94 +/- 8 kg), the ventricular end-systolic and arterial elastances, pressure-volume area, and external work were analyzed during steady-state contractions with traditional hemodynamic parameters with intra-aortic balloon pumping-off and -on (1:1 synchronous ratio). An acute ischemic heart failure was induced by injecting 10 microm microspheres (4.2 +/- 1.8 x 10(7). 100g left ventricular weight-1) into the left main coronary artery; all measurements were repeated. RESULTS Intra-aortic balloon pumping did not change hemodynamic parameters in the control. However, during heart failure, intra-aortic balloon pumping decreased the arterial elastance from 3.6 +/- 1.3 mm Hg to 2.9 +/- 1.2 mm Hg. mL-1 while not affecting the ventricular end-systolic elastance, this resulted in an improvement of the ventriculoarterial coupling ratio from 3.1 +/- 0.8 to 2.3 +/- 0.8. Intra-aortic balloon pumping decreased not only end-systolic pressure (from 69 +/- 16 mm Hg to 64 +/- 19 mm Hg) but end-diastolic volume and pressure (from 139 +/- 38 mL to 137 +/- 37 mL and from 13. 9 mm Hg to 12.8 mm Hg, respectively) with the leftward shift of the pressure-volume loop. Pressure-volume area decreased (from 914 +/- 284 mm Hg to 849 +/- 278 mm Hg. mL) although stroke volume increased (from 21 +/- 6 mL to 24 +/- 6 mL). CONCLUSION Reduction of the arterial elastance with intra-aortic balloon pumping improved the ventriculoarterial coupling ratio and increased stroke volume. Leftward shift of the pressure-volume loop resulted in the reduction of pressure-volume area, which suggests the conservation of the myocardial oxygen consumption.
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Affiliation(s)
- O Kawaguchi
- Department of Surgery, Division of Cardiothoracic Surgery, College of Medicine, The Pennsylvania State University, The Milton S. Hershey Medical Center, Hershey, PA 17033, USA
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Stefanadis C, Dernellis J, Tsiamis E, Stratos C, Kallikazaros I, Toutouzas P. Aortic function in patients during intra-aortic balloon pumping determined by the pressure-diameter relation. J Thorac Cardiovasc Surg 1998; 116:1052-9. [PMID: 9832698 DOI: 10.1016/s0022-5223(98)70058-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The physiologic basis for the hemodynamic and clinical improvement achieved by the use of intra-aortic balloon pumping in patients with cardiogenic shock has not been clarified in all its aspects. This study evaluated the possible contribution of pump-induced alterations of aortic mechanics to the overall benefit gained by the implementation of this therapeutic modality in patients with acute heart failure of ischemic origin. METHODS The aortic pressure-diameter relation was obtained by use of an intravascular catheter for aortic diameter measurements developed in our institution and previously validated, simultaneously with a catheter-tip micromanometer for aortic pressure measurements at the same aortic level. Aortic function indices were compared before and during intra-aortic balloon pumping in 12 patients with cardiogenic shock. RESULTS Intra-aortic balloon pumping increased cardiac index and aortic distensibility by 24% and 30%, respectively, and reduced myocardial oxygen demand by 31% (P <.001 for all alterations). Energy loss caused by aortic wall viscosity increased by 207% (P <. 001). The aortic diameter augmentation index increased by 68% (P <. 001); the aortic pressure augmentation index decreased by 117% (P <. 001). Linear regression analysis showed that cardiac index and myocardial oxygen demand were related with the aortic stiffness constant both before and during intra-aortic balloon pumping. CONCLUSIONS During intra-aortic balloon pumping, aortic distensibility was improved, and wave reflection from the arterial periphery was reduced. The relationship between cardiac index and myocardial oxygen demand and aortic stiffness suggests that improvement of the elastic properties of the aorta was an important mechanism by which intra-aortic balloon pumping improved circulatory function.
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MESH Headings
- Angina, Unstable/complications
- Aorta, Thoracic/diagnostic imaging
- Aorta, Thoracic/physiopathology
- Blood Pressure
- Elasticity
- Female
- Humans
- Intra-Aortic Balloon Pumping
- Male
- Middle Aged
- Monitoring, Intraoperative
- Muscle Contraction
- Muscle, Smooth, Vascular/physiopathology
- Radiography
- Shock, Cardiogenic/etiology
- Shock, Cardiogenic/physiopathology
- Shock, Cardiogenic/surgery
- Treatment Outcome
- Ultrasonography, Interventional
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Affiliation(s)
- C Stefanadis
- Hippokration Hospital, Department of Cardiology, University of Athens, Greece
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Mulay AV, Zacharias S, Hansbro SD, Catchpole RW, Nair RU. Should intraaortic balloon counterpulsation be continued during cardiopulmonary bypass? J Thorac Cardiovasc Surg 1997; 114:1128-9. [PMID: 9434714 DOI: 10.1016/s0022-5223(97)70036-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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