Enhanced coronary blood flow velocity during intraaortic balloon counterpulsation in critically III patients

Abstract

Intraaortic balloon pumping unequivocally and significantly augments proximal coronary blood flow velocity, nearly doubling the coronary flow velocity integral in most patients. This mechanism may be a significant means of ischemia relief in hypotensive patients.

Intra-aortic Balloon Pump Timing: Review of Evidence Supporting Current Practice

“…In a later study, 20 78% of surgical patients tolerated this timing method; 22% required conventional deflation. Kern et al 8 reported similar results and found that coronary blood flow increased as a result of the prolonged inflation.…”

“…In contrast, real-time timing allows deflation to occur during the preejection phase or during early systolic ejection and may increase stroke volume because of active deflation during systolic ejection. 3,8,15,16 …”

“…Hypotensive patients experienced the most significant improvement, with coronary flow increases of greater than 100% during IABP inflation. 8 Properly timed IABP deflation reduces afterload. Schreuder et al 4 confirmed the findings of Cheung et al, 9 showing that an IABP reduced left ventricular end-systolic pressure and volume, improved stroke volume, reduced left ventricular stroke work (LVSW), and reduced left ventricular end-diastolic pressure and volume.…”

“…Deflation timing, however, has a more divergent picture. Most studies [3][4][5][6][7][8]15,16,19,20 find advantages for both conventional and real-time deflation; however, the research appears to favor R-wave deflation. Because both methods are acceptable, deflation timing for each clinical situation must be determined on the basis of the purpose of IABC for the specific patient and assessment of the hemodynamic effects of the selected timing method.…”

Efficacy of Enhanced External Counterpulsation (EECP) in Nepalese chronic stable Angina patient: a single centre prospective study at Shahid Gangalal National Heart Center (SGNHC)

“…8 EECP treatment is associated with an immediate increase in blood flow in multiple vascular beds including the coronary arterial circulation. 7 This increase in blood flow may result in increased endothelial shear stress, 16 which enhances endothelial function by stimulating the release of the vasodilatory mediator nitric oxide and reduces the release of the vasocontractile endothelin-1. 15,[17][18][19] However, most of the experience is from small animal or human uncontrolled studies, and the mechanism of the sustained antianginal benefit with EECP remains unclear.…”