Effect of intraaortic balloon counterpulsation on regional myocardial blood flow and oxygen consumption in the presence of coronary artery stenosis: Observations in an awake animal model

Abstract

The mechanism by which intraaortic balloon pumping ameliorates myocardial ischemia in patients with unstable angina pectoris is uncertain. Accordingly, the following study was performed to determine the effect of intraaortic balloon pumping on regional myocardial blood flow and myocardial oxygen consumption (MVO 2) distal to severe coronary artery stenosis. Nine closed chest conscious pigs were instrumented with a 7.5 mm long plastic stenosis which reduced vessel diameter by 82%. Measurements of hemodynamics, regional myocardial blood flow (microsphere technique) and MVO 2 were made (1) before intraaortic balloon pumping, (2) at the end of 15 to 20 minutes of intraaortic balloon pumping, and (3) 20 minutes after its discontinuation. Control endocardial blood flow (ml · min − 1 · g − 1) distal to the stenosis (1.04 ± 0.20, mean ± 1 standard deviation [SD]) was less than endocardial flow in myocardium perfused by the unobstructed circumflex coronary artery (1.67 ± 0 0.77, p < 0.01). Likewise, control distal zone epicardial flow (1.16 ± 0.36) was reduced in comparison with control circumflex zone epicardial flow (1.48 ± 0.60, p < 0.01 In response to intraaortic balloon pumping rate-pressure product declined versus control (10,300 ± 2,090 [SD] mm Hg · min − 1 to 9,110 ± 2,010, p < 0.005), whereas aortic mean diastolic pressure (mm Hg) increased versus control (109.0 ± 9.9 to 121.0 ± 13.8, p < 0.01). Distal coronary mean diastolic pressure did not change in response to intraaortic balloon pumping (61.9 ± 13.0 to 68.7 ± 16.5, p = NS). Likewise, endocardial blood flow (ml · min − 1 · − 1) distal to the stenosis did not change during intraaortic balloon pumping (1.00 ± 0.24) versus control (1.04 ± 0.20). In contrast, during intraaortic balloon pumping epicardial blood flow distal to the stenosis declined versus control (1.16 ± 0.36 to 1.01 ± 0.27, p < 0.05). Regional MVO 2 (ml · min − 1 · 100 g − 1) distal to the stenosis also decreased versus control in response to intraaortic balloon pumping (12.90 ± 3.55 to 10.30 ± 2.52, p < 0.05). Furthermore, regional MVO 2 correlated well ( r = 0.74, p < 0.002) with rate-pressure product. Thus, intraaortic balloon pumping reduces myocardial oxygen demand but does not improve blood flow distal to a severe coronary stenosis; (2) blood flow distal to a severe stenosis may fail to increase with intraaortic balloon pumping because (A) distal coronary mean diastolic pressure may not increase, and (B) blood vessels distal to the stenosis tend to autoregulate in response to a decline in myocardial oxygen demand; and (3) intraaortic balloon pumping ameliorates myocardial ischemia in patients with unstable angina pectoris primarily by reducing oxygen demand rather than by increasing oxygen supply.