Yoshitani Hidetoshi, Akasaka Takashi, Kaji Shuichiro, Kawamoto Takahiro, Kume Teruyoshi, Neishi Yoji, Koyama Yuji, Yoshida Kiyoshi
Department of Internal Medicine and Cardiology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
Am Heart J. 2007 Oct;154(4):725-31. doi: 10.1016/j.ahj.2007.05.019.
The benefits of intra-aortic balloon pumping (IABP) usage reportedly occur through systolic unloading of the left ventricle and the augmentation of diastolic coronary flow. The aim of this study was to assess the change in intracoronary pressure distal to the coronary stenosis after the IABP by using an intracoronary pressure wire.
Hemodynamic variables and intracoronary pressure data were measured in 16 patients requiring IABP for clinical indication (11 vessels with coronary stenosis and 5 normal vessels were enrolled). Coronary pressure was measured directly in each vessel with and without IABP support.
The diastolic aortic pressure during IABP increased compared with that without the IABP (97.9 +/- 11.7 vs 80.3 +/- 10.7 mm Hg, P < .01). The systolic aortic and intracoronary pressure during the IABP decreased (aortic pressure: 83.8 +/- 10.4 vs 95.9 +/- 11.3 mm Hg, P < .01, intracoronary pressure: 67.6 +/- 16.5 vs 76.2 +/- 20.4 mm Hg, P < .01). The diastolic distal coronary pressure (Pd) increased during the IABP in healthy coronary arteries (87.3 +/- 4.8 vs 72.1 +/- 10.3 mm Hg, P < .05). However, Pd in stenotic coronary arteries with the IABP did not increase statistically compared with those without the IABP (44.0 +/- 21.3 vs 42.8 +/- 17.9 mm Hg). There was a significant correlation between the change in Pd after IABP insertion and percent diameter stenosis calculated by quantitative coronary angiography (r2 = 0.51, P < .001).
In the presence of a critical coronary stenosis, the IABP does not increase the diastolic coronary pressure distal to the stenosis. Thus, the major effect of IABP on high-risk patients with severe coronary stenosis may relate to the reduction of oxygen demand by systolic unloading more than diastolic augmentation of the coronary flow.
据报道，主动脉内球囊反搏（IABP）的益处是通过左心室收缩期卸载和舒张期冠状动脉血流增加来实现的。本研究的目的是使用冠状动脉压力导丝评估IABP后冠状动脉狭窄远端的冠状动脉内压力变化。
对16例因临床指征需要IABP的患者（纳入11条有冠状动脉狭窄的血管和5条正常血管）进行血流动力学变量和冠状动脉内压力数据测量。在有和没有IABP支持的情况下，直接测量每条血管的冠状动脉压力。
与没有IABP相比，IABP期间的舒张期主动脉压力升高（97.9±11.7对80.3±10.7 mmHg，P<.01）。IABP期间的收缩期主动脉和冠状动脉内压力降低（主动脉压力：83.8±10.4对95.9±11.3 mmHg，P<.01，冠状动脉内压力：67.6±16.5对76.2±20.4 mmHg，P<.01）。在健康冠状动脉中，IABP期间舒张期冠状动脉远端压力（Pd）升高（87.3±4.8对72.1±10.3 mmHg，P<.05）。然而，与没有IABP相比，有IABP的狭窄冠状动脉中的Pd没有统计学上的增加（44.0±21.3对42.8±17.9 mmHg）。IABP插入后Pd的变化与通过定量冠状动脉造影计算的直径狭窄百分比之间存在显著相关性（r2=0.51，P<.001）。
在存在严重冠状动脉狭窄的情况下，IABP不会增加狭窄远端的舒张期冠状动脉压力。因此，IABP对患有严重冠状动脉狭窄的高危患者的主要作用可能与通过收缩期卸载降低氧需求有关，而不是舒张期增加冠状动脉血流。
