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Journal of Cardiovascular Translational Research

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Open Access 01-08-2019 | Intra-Aortic Balloon | Original Article

Intra-aortic Balloon Counterpulsation for High-Risk Percutaneous Coronary Intervention: Defining Coronary Responders

Authors: Natalia Briceno, Kalpa De Silva, Matthew Ryan, Tiffany Patterson, Kevin O’Gallagher, Howard Ellis, Simone Rivolo, Jack Lee, Simon Redwood, Ajay M. Shah, Michael Marber, Divaka Perera

Published in: Journal of Cardiovascular Translational Research | Issue 4/2019

Abstract

The effect of intra-aortic balloon counterpulsation (IABC) varies, and it is unknown whether this is due to a heterogeneous coronary physiological response. This study aimed to characterise the coronary and left ventricular (LV) effects of IABC and define responders in terms of their invasive physiology. Twenty-seven patients (LVEF 31 ± 9%) underwent coronary pressure and Doppler flow measurements in the target vessel and acquisition of LV pressure volume loops after IABC supported PCI, with and without IABC assistance. Through coronary wave intensity analysis, perfusion efficiency (PE) was calculated as the proportion of total wave energy comprised of accelerating waves, with responders defined as those with an increase in PE with IABC. The myocardial supply/demand ratio was defined as the ratio between coronary flow and LV pressure volume area (PVA). Responders (44.4%) were more likely to have undergone complex PCI (p = 0.03) with a higher pre-PCI disease burden (p = 0.02) and had lower unassisted mean arterial (87.4 ± 11.0 vs. 77.8 ± 11.6 mmHg, p = 0.04) and distal coronary pressures (88.0 ± 11.0 vs. 71.6 ± 12.4 mmHg, p < 0.001). There was no effect overall of IABC on the myocardial supply/demand ratio (p = 0.34). IABC has minimal effect on demand, but there is marked heterogeneity in the coronary response to IABC, with the greatest response observed in those patients with the most disordered autoregulation.

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Title: Intra-aortic Balloon Counterpulsation for High-Risk Percutaneous Coronary Intervention: Defining Coronary Responders
Authors: Natalia Briceno
Kalpa De Silva
Matthew Ryan
Tiffany Patterson
Kevin O’Gallagher
Howard Ellis
Simone Rivolo
Jack Lee
Simon Redwood
Ajay M. Shah
Michael Marber
Divaka Perera
Publication date: 01-08-2019
Publisher: Springer US
Keyword: Intra-Aortic Balloon
Published in: Journal of Cardiovascular Translational Research / Issue 4/2019
Print ISSN: 1937-5387
Electronic ISSN: 1937-5395
DOI: https://doi.org/10.1007/s12265-019-09871-8

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Intra-aortic Balloon Counterpulsation for High-Risk Percutaneous Coronary Intervention: Defining Coronary Responders

Abstract

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Abstract

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