EVALUATION DURING INTRA-AORTIC BALLOON COUNTERPULSATION CORONARY AND MICROVASCULAR PHYSIOLOGY
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Keywords
IABP, Circulatory Support Device, Intra-aortic balloon pump, Ischemic cardiomyopathy
Abstract
Background: This research aimed to assess how coronary autoregulation influences myocardial perfusion during the use of an Intra-aortic Balloon Pump (IABP). The IABP is a popular “circulatory support device”. Changes in microvascular function have not previously been investigated in people regarding IABP efficacy.
Methodology: The study was conducted at the National Institute of Cardiovascular Disease (NIVD) Karachi. The study included 20 “patients with ischemic cardiomyopathy left ventricular ejection fraction" 36 ± 10%) who had "percutaneous coronary intervention". Following the intervention, “intracoronary pressure and Doppler flow measurements were conducted simultaneously in the chosen vessel both unassisted and with IABP". To obtain maximum hyperemia, coronary autoregulation was changed by intracoronary adenosine. “Wave intensity analysis determined the coronary wave energies associated with ballooning counterpulsation”.
Result: “Intra-aortic balloon pump therapy” generated two distinct diastolic coronary waves: a “forward compression wave” during balloon inflation and a “forward expansion wave” during balloon deflation. Under “basal conditions, IABP increased distal coronary pressure” (84.42 ± 18.12 vs. 90.72 ± 19.82 mm Hg, p = 0.04) and “microvascular resistance” (2.342 ± 0.542 vs. 3.292 ± 0.432, p 0.002), “with no change in average peak velocity” (32.62 ± 14.02 vs. 28.62 ± 13.32, p 0.68). “When autoregulation was disabled, IABP increased average peak velocity” (41.42 ± 12.52 vs. 46.72 ± 19.52, p 0.03), and this rise was linearly related to “IABP” -forward compression wave energy (R² = 0.82, p = 0.02).
Conclusion: Autoregulation Coronary reduces the impact of “IABP on coronary blood flow”. “However, during hyperemia, IABP improves myocardial perfusion primarily due to a diastolic forward compression wave from balloon inflation”. This suggests that “IABP” is most effective when the microcirculatory reserve is depleted.
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Dr Shafiq Alam
Assistant Professor, Cardiology Department, Bacha Khan Medical College, MTI Mardan, Pakistan
Dr Sumaiya Muhammad Iqbal Memon
Senior Registrar Emergency Department, NICVD, Karachi Pakistan
Dr Ameena Palwasha
Senior Lecturer, Department of Physiology, Jinnah Medical College, Peshawar Pakistan
Dr Syed Soban Ahmed Tirimzi
Assistant Professor, Department of Physiology, Abbottabad International Medical Institute, Abbottabad Pakistan
Dr Gul Muhammad
Assistant Professor, Department of Physiology, Rehman Medical College, Peshawar Pakistan
Dr Muhammad Umair
Assistant Professor, Department of Physiology, Gomal Medical College, MTI, Dera Ismail Khan Pakistan