Enhanced coronary flow velocity during intra-aortic balloon pumping assessed by transthoracic Doppler echocardiography.
OBJECTIVE
The study was done to determine potential utility of measuring coronary flow velocity (CFV) by transthoracic Doppler echocardiography (TTDE) during intra-aortic balloon pumping (IABP).


BACKGROUND
Use of IABP has been shown to increase CFV assessed by an invasive technique. The CFV in the left anterior descending coronary artery (LAD) can be measured by TTDE.


METHODS
Coronary flow velocity in the distal LAD by TTDE was measured in 40 critically ill patients requiring IABP. All patients received emergency coronary angiography. Both CFV and pressure data were obtained during 1:2 balloon pumping.


RESULTS
Adequate diastolic CFV recording was obtained in all patients. The IABP decreased systolic pressure and increased diastolic pressure. Average peak diastolic flow velocity and diastolic velocity time integral was 19 +/- 11 cm/s and 7.7 +/- 4.4 cm with non-augmented beat. These values were increased significantly (61 +/- 38%, 59 +/- 35%, p < 0.001) with augmented beat. Significant correlation was noted between % diastolic pressure augmentation and % increase in diastolic CFV (r = 0.62 to 0.69, p < 0.001). There was no significant difference in flow enhancement during IABP, irrespective to the proximal LAD stenosis severity (severe stenosis: 73 +/- 70%; intermediate stenosis: 61 +/- 29%; no significant stenosis: 58 +/- 29%; p = NS, analysis of variance). By continuous recording of CFV, the optimal timing of balloon control could be adjusted to maximize flow velocity during augmentation.


CONCLUSIONS
Use of TTDE can be employed in monitoring CFV augmentation during IABP. The IABP produced significant distal flow enhancement even in patients with critical proximal stenosis. This totally noninvasive approach may help to optimize the benefits of IABP for coronary flow augmentation.
Takeuchi
Masaaki
M
Department of Internal Medicine, Tane General Hospital, 1-2-31 Sakaigawa, Nishi-ku, Osaka 500-0024, Japan. masaaki_takeuchi@hotmail.com
Nohtomi
Yuichi
Y
Yoshitani
Hidetoshi
H
Miyazaki
Chinami
C
Sakamoto
Kazuo
K
Yoshikawa
Junichi
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity / Q000502:physiology*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D003326:Coronary Circulation / Q000502:physiology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004452:Echocardiography; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013997:Time Factors