title: Intra-aortic balloon pump (IABP) counterpulsation improves cerebral perfusion in patients with decreased left ventricular function.
abstract: BACKGROUND
  The current goal of treatment after acute ischemic stroke is the increase of cerebral blood flow (CBF) in ischemic brain tissue. Intra-aortic balloon pump (IABP) counterpulsation in the setting of cardiogenic shock is able to reduce left ventricular afterload and increase coronary blood flow. The effects of an IABP on CBF have not been sufficiently examined. We hypothesize that the use of an IABP especially enhances cerebral blood flow in patients with pre-existing heart failure.
  
  
  METHODS
  In this pilot study, 36 subjects were examined to investigate the effect of an IABP on middle cerebral artery (MCA) transcranial Doppler (TCD) flow velocity change and relative CBF augmentation by determining velocity time integral changes (ΔVTI) in a constant caliber of the MCA compared to a baseline measurement without an IABP. Subjects were divided into two groups according to their left ventricular ejection fraction (LVEF): Group 1 LVEF >30% and Group 2 LVEF ≤30%.
  
  
  RESULTS
  Both groups showed an increase in CBF using an IABP. Patients with a LVEF ≤30% showed a significantly higher increase of ΔVTI in the MCA under IABP augmentation compared to patients with a LVEF >30% (20.9% ± 3.9% Group 2 vs.10.5% ± 2.2% Group 1, p<0,05). The mean arterial pressure (MAP) increased only marginally in both groups under IABP augmentation.
  
  
  CONCLUSIONS
  IABP improves cerebral blood flow, particularly in patients with pre-existing heart failure and highly impaired LVEF. Hence, an IABP might be a treatment option to improve cerebral perfusion in selected patients with cerebral misperfusion and simultaneously existing severe heart failure.
authors.affiliation: University of Technology Dresden, Heart Center Dresden, University Hospital, Dresden, Germany christian.pfluecke@mailbox.tu-dresden.de.
authors.forename: C
authors.initials: C
authors.lastname: Pfluecke
authors.affiliation: University of Technology Dresden, Heart Center Dresden, University Hospital, Dresden, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Christoph
authors.affiliation: University of Technology Dresden, Heart Center Dresden, University Hospital, Dresden, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Kolschmann
authors.affiliation: University of Technology Dresden, Heart Center Dresden, University Hospital, Dresden, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Tarnowski
authors.affiliation: University of Technology Dresden, Heart Center Dresden, University Hospital, Dresden, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Forkmann
authors.affiliation: University of Technology Dresden, Heart Center Dresden, University Hospital, Dresden, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Jellinghaus
authors.affiliation: University of Technology Dresden, Heart Center Dresden, University Hospital, Dresden, Germany.
authors.forename: D M
authors.initials: DM
authors.lastname: Poitz
authors.affiliation: University of Technology Dresden, Heart Center Dresden, University Hospital, Dresden, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Wunderlich
authors.affiliation: University of Technology Dresden, Heart Center Dresden, University Hospital, Dresden, Germany.
authors.forename: R H
authors.initials: RH
authors.lastname: Strasser
authors.affiliation: University of Technology Dresden, Heart Center Dresden, University Hospital, Dresden, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Schoen
authors.affiliation: University of Technology Dresden, Heart Center Dresden, University Hospital, Dresden, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Ibrahim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D002560:Cerebrovascular Circulation; D003326:Coronary Circulation; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D010477:Perfusion; D017585:Ultrasonography, Doppler, Transcranial; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*
keywords: IABP; cardiogenic shock; cerebral blood flow; cerebral perfusion; heart failure; intra-aortic balloon counterpulsation