Remmelink Maurice, Sjauw Krischan D, Henriques José P S, de Winter Robbert J, Koch Karel T, van der Schaaf René J, Vis Marije M, Tijssen Jan G P, Piek Jan J, Baan Jan
Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Catheter Cardiovasc Interv. 2007 Oct 1;70(4):532-7. doi: 10.1002/ccd.21160.
We studied the effects of LV unloading by the Impella on coronary hemodynamics by simultaneously measuring intracoronary pressure and flow and the derived parameters fractional flow reserve (FFR), coronary flow velocity reserve (CFVR), and coronary microvascular resistance (MR).
Patients with compromised left ventricular (LV) function undergoing high-risk percutaneous coronary intervention (PCI) may benefit from LV unloading. Limited information is available on the effects of LV unloading on coronary hemodynamics.
Eleven patients (mean LV ejection fraction of 35 +/- 11%) underwent PCI during LV support by the LV unloading device (Impella Recover LP2.5). Intracoronary measurements were performed in a nonstenotic coronary artery after the PCI, before and after adenosine-induced hyperemia at four different support levels (0-2.5 L/min).
Aortic and coronary pressure increased with increasing support levels, whereas FFR remained unchanged. Baseline flow velocity remained unchanged, while hyperemic flow velocity and CFVR increased significantly with increasing support levels (61 +/- 24 to 72 +/- 27 cm/sec, P = 0.001 and 1.88 +/- 0.52 to 2.34 +/- 0.63, P < 0.001 respectively). The difference between baseline MR and hyperemic MR significantly increased with increasing support levels (1.28 +/- 1.32 to 1.89 +/- 1.43 mm Hg cm(-1) sec, P = 0.005).
Unloading of the LV by the Impella increased aortic and intracoronary pressure, hyperemic flow velocity and CFVR, and decreased MR. The Impella-induced increase in coronary flow, probably results from both an increased perfusion pressure and a decreased LV volume-related intramyocardial resistance.
我们通过同时测量冠状动脉内压力和血流以及衍生参数血流储备分数（FFR）、冠状动脉血流速度储备（CFVR）和冠状动脉微血管阻力（MR），研究了Impella左心室卸载对冠状动脉血流动力学的影响。
左心室（LV）功能受损的患者接受高风险经皮冠状动脉介入治疗（PCI）可能受益于左心室卸载。关于左心室卸载对冠状动脉血流动力学影响的信息有限。
11例患者（平均左心室射血分数为35±11%）在使用左心室卸载装置（Impella Recover LP2.5）进行左心室支持期间接受PCI。在PCI后，于四条不同支持水平（0 - 2.5升/分钟）下，在一条无狭窄的冠状动脉内进行腺苷诱发充血前后的测量。
随着支持水平的增加，主动脉和冠状动脉压力升高，而FFR保持不变。基础血流速度保持不变，而充血血流速度和CFVR随着支持水平的增加显著增加（分别从61±24厘米/秒增至72±27厘米/秒，P = 0.001；从1.88±0.52增至2.34±0.63，P < 0.001）。随着支持水平的增加基线MR和充血MR之间的差异显著增加（从1.28±1.32毫米汞柱厘米⁻¹秒增至1.89±1.43毫米汞柱厘米⁻¹秒，P = 0.005）。
Impella对左心室的卸载增加了主动脉和冠状动脉内压力、充血血流速度和CFVR，并降低了MR。Impella引起的冠状动脉血流增加可能是灌注压力增加和左心室容积相关心肌内阻力降低共同作用的结果。
