TY - JOUR
T1 - Intra-aortic Balloon Counterpulsation for High-Risk Percutaneous Coronary Intervention
T2 - Defining Coronary Responders
AU - Briceno, Natalia
AU - De Silva, Kalpa
AU - Ryan, Matthew
AU - Patterson, Tiffany
AU - O’Gallagher, Kevin
AU - Ellis, Howard
AU - Rivolo, Simone
AU - Lee, Jack
AU - Redwood, Simon
AU - Shah, Ajay M.
AU - Marber, Michael
AU - Perera, Divaka
PY - 2019/8/15
Y1 - 2019/8/15
N2 - 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.
AB - 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.
KW - Coronary perfusion efficiency
KW - Coronary responders
KW - Intra-aortic balloon counterpulsation
KW - Myocardial supply/demand ratio
KW - Wave intensity analysis
UR - http://www.scopus.com/inward/record.url?scp=85063067458&partnerID=8YFLogxK
U2 - 10.1007/s12265-019-09871-8
DO - 10.1007/s12265-019-09871-8
M3 - Article
AN - SCOPUS:85063067458
SN - 1937-5387
VL - 12
SP - 299
EP - 309
JO - Journal of cardiovascular translational research
JF - Journal of cardiovascular translational research
IS - 4
ER -