Influence of intraaortic balloon pump counterpulsation on transesophageal echocardiography derived determinants of diastolic function.
BACKGROUND
Intraaortic balloon pump counterpulsation (IABP) is often used in patients with acute coronary syndrome for its favourable effects on left ventricular (LV) systolic function and coronary perfusion. However, the effects of IABP on LV diastolic function have not been comprehensively investigated. Acute diastolic dysfunction has been linked to increased morbidity and mortality. The aim of this study was to examine the influence of IABP on LV diastolic dysfunction using standard TEE derived parameters.


METHODS
Intraoperative TEE was performed in 10 patients (mean age 65 ± 11 yrs) undergoing urgent coronary artery bypass graft surgery (CABG), who had received an IABP preoperatively. TEE derived measures of diastolic dysfunction included early to late transmitral Doppler inflow velocity ratio (E/A), deceleration time (Dt), pulmonary venous systolic to diastolic Doppler velocity ratio (S/D), transmitral propagation velocity (Vp), and the ratio of early to late mitral annular tissue Doppler velocities (e'/a'). Statistical analyses included the Wilcoxon Sign-Rank test, and a p<0.05 was considered significant.


RESULTS
Transmitral inflow E/A ratios increased significantly from 0.86 to 1.07 (p < 0.05), while Dt decreased significantly from 218 to 180 ms (p < 0.05) with the use of IABP. Significant increases in Vp (34 cm/s to 43 cm/s; p < 0.05), and e'/a' (0.58 to 0.71; p < 0.05) suggested a favourable influence of intraaortic counterpulsation on diastolic function.


CONCLUSIONS
The use of perioperative IABP significantly improves TEE derived parameters of diastolic function consistent with a favourable impact on LV relaxation in cardiac surgery patients undergoing CABG.
Klinik für Anaesthesiologie und Intensivmedizin, Universitätsklinikum Tübingen, Germany.
Martina
M
Nowak-Machen
Klinik für Anaesthesiologie und Intensivmedizin, Universitätsklinikum Tübingen, Germany; Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
Jan N
JN
Hilberath
Klinik für Anaesthesiologie und Intensivmedizin, Universitätsklinikum Tübingen, Germany.
Peter
P
Rosenberger
Klinik für Anaesthesiologie und Intensivmedizin, Universitätsklinikum Tübingen, Germany.
Eckhard
E
Schmid
Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, United States of America.
Stavros G
SG
Memtsoudis
Klinik für Anaesthesiologie und Intensivmedizin, Universitätsklinikum Tübingen, Germany.
Johannes
J
Angermair
Department of Statistics, University of Toronto, Toronto, Canada.
Jayshree K
JK
Tuli
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
Stanton K
SK
Shernan
D003971:Diastole / Q000502:physiology*; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged