主动脉内球囊反搏泵在晚期心力衰竭中的急性血液动力学效应。
Acute Hemodynamic Effects of Intra-aortic Balloon Counterpulsation Pumps in Advanced Heart Failure.
机构信息
The Molecular Cardiology Research Institute, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts; The Acute Mechanical Circulatory Support Working Group, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts; The Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts.
The Molecular Cardiology Research Institute, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts; The Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts.
出版信息
J Card Fail. 2017 Aug;23(8):606-614. doi: 10.1016/j.cardfail.2017.05.015. Epub 2017 May 26.
BACKGROUND
The utility of intra-aortic balloon counterpulsation pumps (IABPs) in low cardiac output states is unknown and no studies have explored the impact of IABP therapy on ventricular workload in patients with advanced heart failure (HF). For these reasons, we explored the acute hemodynamic effects of IABP therapy in patients with advanced HF.
METHODS
We prospectively studied 10 consecutive patients with stage D HF referred for IABP placement before left ventricular assist device (LVAD) surgery and compared with 5 control patients with preserved left ventricular (LV) ejection fraction (EF) who did not receive IABP therapy. Hemodynamics were recorded using LV conductance and pulmonary artery catheters. Cardiac index (CI)-responder and CI-nonresponder status was assigned a priori as being "equal to or above" or below the median of the IABP effect on CI, respectively, within 24 hours after IABP activation.
RESULTS
Compared with controls, patients with advanced HF had lower LVEF, lower LV end-systolic pressure, lower LV stroke work, and higher LV end-diastolic pressures and volumes before IABP activation. IABP activation reduced LV stroke work primarily by reducing end-systolic pressure. IABP therapy increased CI by a median of 20% as well as increased diastolic pressure time index and the myocardial oxygen supply:demand ratio. Compared with CI-nonresponders, CI-responders had higher systemic vascular resistance, lower right heart filling pressures, and a trend toward lower left heart filling pressures with improved indices of right heart function. Compared with CI-nonresponders, the diastolic pressure time index was increased among CI-responders.
CONCLUSIONS
IABP therapy may be effective at reducing LV stroke work, increasing CI, and favorably altering the myocardial oxygen supply:demand ratio in patients with advanced HF, especially among patients with low right heart filling pressures and high systemic vascular resistance.
背景
在低心输出量状态下，主动脉内球囊反搏泵（IABP）的效用尚不清楚，也没有研究探讨 IABP 治疗对晚期心力衰竭（HF）患者心室负荷的影响。基于这些原因，我们探讨了 IABP 治疗对晚期 HF 患者急性血液动力学的影响。
方法
我们前瞻性研究了 10 例连续接受 IABP 治疗的 D 期 HF 患者，并与 5 例未接受 IABP 治疗的保留左心室（LV）射血分数（EF）的对照组患者进行比较。使用 LV 导纳和肺动脉导管记录血液动力学。在 IABP 激活后 24 小时内，根据 IABP 对 CI 的影响中位数，将 CI 反应者和 CI 无反应者状态预先定义为“等于或高于”或低于中位数。
结果
与对照组相比，晚期 HF 患者的 LVEF 较低，LV 收缩末期压力较低，LV 每搏功较低，LV 舒张末期压力和容积较高。IABP 激活主要通过降低收缩末期压力来降低 LV 每搏功。IABP 治疗使 CI 中位数增加 20%，同时增加舒张期压力时间指数和心肌氧供：需求比。与 CI 无反应者相比，CI 反应者的全身血管阻力较高，右心充盈压较低，左心充盈压有降低趋势，右心功能指标改善。与 CI 无反应者相比，CI 反应者的舒张期压力时间指数增加。
结论
IABP 治疗可能有效降低 LV 每搏功，增加 CI，并有利地改变晚期 HF 患者的心肌氧供：需求比，尤其是在右心充盈压低、全身血管阻力高的患者中。
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