Kapur Navin K, Paruchuri Vikram, Majithia Arjun, Esposito Michele, Shih Henry, Weintraub Andrew, Kiernan Michael, Pham Duc Thinh, Denofrio David, Kimmelstiel Carey
Tufts University School of Medicine, Division of Cardiology, Boston, MA, USA.
J Invasive Cardiol. 2015 Apr;27(4):182-8.
Several recent trials have examined the clinical utility of intraaortic balloon counterpulsation pumps (IABPs) in cardiogenic shock and acute coronary syndromes. More recently, a larger-capacity 50 cc IABP was introduced into practice. No data comparing the hemodynamic effects of the 40 cc vs 50 cc IABP exist. Our aim was to explore the hemodynamic effects of the 50 cc IABP in real-world clinical practice.
Demographic, hemodynamic, and laboratory data were retrospectively examined in 26 consecutive subjects treated with a 50 cc IABP and compared with 26 patients receiving a 40 cc IABP between 2012 and 2013. IABP tracings were analyzed within 24 hours of implantation in all patients. Pulmonary artery catheter data were available before and after IABP implantation in 20 subjects.
Baseline demographics, including body surface area, were similar between groups. Compared with the 40 cc IABP group, 50 cc IABP recipients showed higher augmented diastolic blood pressure, greater systolic unloading, and a larger reduction in pulmonary capillary occlusion pressure (PCOP). Percent diastolic augmentation was higher among 50 cc IABP recipients. Only 58% of subjects achieved <10 mm Hg of systolic unloading in the 40 cc group compared with 27% in the 50 cc group. For both the 40 cc and 50 cc IABPs, the magnitude of systolic unloading correlated inversely with PCOP and directly with the magnitude of diastolic augmentation.
In real-world practice, greater systolic unloading and diastolic augmentation were observed among 50 cc vs 40 cc IABP recipients. Future trials evaluating the clinical utility of the 50 cc IABP are required.
最近有多项试验探讨了主动脉内球囊反搏泵（IABP）在心源性休克和急性冠脉综合征中的临床应用价值。最近，一种容量更大的50 cc IABP开始应用于临床。目前尚无比较40 cc与50 cc IABP血流动力学效应的数据。我们的目的是在实际临床实践中探究50 cc IABP的血流动力学效应。
回顾性分析了2012年至2013年间连续接受50 cc IABP治疗的26例患者的人口统计学、血流动力学和实验室数据，并与26例接受40 cc IABP治疗的患者进行比较。对所有患者在植入IABP后24小时内的IABP波形进行分析。20例患者在植入IABP前后可获得肺动脉导管数据。
两组患者的基线人口统计学数据，包括体表面积，相似。与40 cc IABP组相比，接受50 cc IABP的患者舒张期血压升高幅度更大，收缩期负荷减轻更明显，肺毛细血管楔压（PCOP）降低幅度更大。50 cc IABP患者的舒张期增压百分比更高。40 cc组中只有58%的患者收缩期负荷减轻<10 mmHg，而50 cc组为27%。对于40 cc和50 cc的IABP，收缩期负荷减轻的幅度与PCOP呈负相关，与舒张期增压幅度呈正相关。
在实际临床实践中，接受50 cc IABP的患者比接受40 cc IABP的患者收缩期负荷减轻更明显，舒张期增压更显著。未来需要进行评估50 cc IABP临床应用价值的试验。
