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      The Effect of Intra-Aortic Balloon Counterpulsation on Coronary Blood Flow Velocity Distal to Coronary Artery Stenoses

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      Cardiology

      S. Karger AG

      Intra-aortic balloon counterpulsation, Coronary blood flow, Coronary artery disease

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          Abstract

          Despite the accepted clinical benefit of intra-aortic balloon counterpulsation (IABC), the physiologic explanation for its benefit remains controversial. Indirect methods of measuring coronary blood flow during IABC in obstructive coronary disease have yielded conflicting results. The direct measurement of coronary blood flow velocity distal to sites of stenoses by methods that do not potentially impede flow has not been previously reported. The aim of our study was to determine the effect of IABC on coronary blood flow velocity distal to a coronary stenosis by employing a method that would not impede flow through the stenosis. In an open-chest canine model, phasic and mean left anterior descending coronary artery flow velocities distal to varying degrees of stenosis were continuously measured by an epicardial Doppler probe with and without counterpulsation. All hemodynamic parameters were recorded in the absence of stenosis (n = 5) and the presence of subcritical (n = 5) and critical stenoses (n = 5). Heart rate was not affected by counterpulsation. Systolic blood pressure and rate-pressure product declined at all times with IABC. Compared to baseline, peak aortic diastolic pressure was augmented by an average of 24 mm Hg during IABC (p < 0.05). However, mean coronary artery flow velocities remained unchanged (101, 103 and 98% of baseline for no stenosis, subcritical stenosis and critical stenosis, respectively; p > 0.05 compared to baseline). Peak diastolic flow velocities were 106,102 and 96% of baseline for no stenosis, subcritical and critical stenoses, respectively (p > 0.05). Despite the augmentation of peak diastolic pressure, distal coronary blood flow velocity was not increased by IABC in this canine model, irrespective of the severity of proximal coronary stenosis. These data suggest that augmentation of coronary artery flow distal to sites of stenoses is not primarily responsible for the clinical benefit observed when IABC is used in the setting of obstructive coronary artery disease. The reduction in afterload and myocardial oxygen demand observed in this model agrees with previous studies and likely accounts, at least in part, for the positive clinical results with IABC.

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          Author and article information

          Journal
          CRD
          Cardiology
          10.1159/issn.0008-6312
          Cardiology
          S. Karger AG
          0008-6312
          1421-9751
          1996
          1996
          19 November 2008
          : 87
          : 4
          : 306-312
          Affiliations
          University of Maryland School of Medicine, Division of Cardiology, Baltimore, Md., USA
          Article
          177111 Cardiology 1996;87:306–312
          10.1159/000177111
          8793165
          © 1996 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 7
          Categories
          General Cardiology

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