Effects Of Intra-aortic Balloon Counterpulsation Research Articles

Effects of intra-aortic balloon pump on in-hospital outcomes and 1-year mortality in patients with acute myocardial infarction complicated by cardiogenic shock

BackgroundThe role of intra-aortic balloon counterpulsation (IABP) in cardiogenic shock complicating acute myocardial infarction (AMI) is still a subject of intense debate. In this study, we aim to investigate the effect of IABP on the clinical outcomes of patients with AMI complicated by cardiogenic shock undergoing percutaneous coronary intervention (PCI).MethodsFrom the Medical Information Mart for Intensive Care (MIMIC)-IV 2.2, 6017 AMI patients were subtracted, and 250 patients with AMI complicated by cardiogenic shock undergoing PCI were analyzed. In-hospital outcomes (death, 24-hour urine volumes, length of ICU stays, and length of hospital stays) and 1-year mortality were compared between IABP and control during the hospital course and 12-month follow-up.ResultsAn IABP was implanted in 30.8% (77/250) of patients with infarct-related cardiogenic shock undergoing PCI. IABP patients had higher levels of Troponin T (3.94 [0.73–11.85] ng/ml vs. 1.99 [0.55–5.75] ng/ml, p-value = 0.02). IABP patients have a longer length of ICU and hospital stays (124 [63–212] hours vs. 83 [43–163] hours, p-value = 0.005; 250 [128–435] hours vs. 170 [86–294] hours, p-value = 0.009). IABP use was not associated with lower in-hospital mortality (33.8% vs. 33.0%, p-value = 0.90) and increased 24-hour urine volumes (2100 [1455–3208] ml vs. 1915 [1110–2815] ml, p-value = 0.25). In addition, 1-year mortality was not different between the IABP and the control group (48.1% vs. 48.0%; hazard ratio 1.04, 95% CI 0.70–1.54, p-value = 0.851).ConclusionIABP may be associated with longer ICU and hospital stays but not better short-and long-term clinical prognosis.

Arterial elastance modulation by intra-aortic balloon counterpulsation in patients with acute decompensated heart failure and low-output state

: Heart failure is characterized by ventriculo-arterial decoupling which decreases myocardial efficiency and is exacerbated by tachycardia and by increased total peripheral resistance that worsen static arterial elastance; unlike aortic pressure by itself, this measure is independent of the function of the ventricle. Therefore, it is an index which describes arterial properties.We investigated the effect of intra-aortic balloon counterpulsation on arterial elastance, a variable which can be obtained non-invasively, in patients with acute decompensated heart failure deteriorated in low output state.17 out of 24 patients admitted for acute decompensated heart failure underwent intra-aortic balloon counterpulsation insertion for hemodynamic worsening condition despite medical therapy.Hemodynamic variables were obtained with a pulmonary artery catheter; arterial elastance and cardiac power index were calculated.Intra-aortic balloon counterpulsation was associated with a decrease of the arterial elastance median value (1.64 vs. 1.28 mmHg/ml- P = 0.04) along withan increase in cardiac power index (0.29, vs 0.40, W/m; P = 0.02 ). Mixed venous saturation (53 mmHg, vs 70 mmHg; P = 0.007) and pulmonary mean arterial pressure (41 vs 30 mmHg; P = 0.005) significantly changed after intraortic balloon counterpulsation insertion. No significant changes in heart rate (median 80, vs 80, bpm; P = 0.809) were observed.Intraortic balloon counterpulsation may effectively improve arterial elastance on top of a conservative use of inotropes/vasopressors, with a significant improvement in hemodynamics.

Intra-aortic Balloon Counterpulsation for High-Risk Percutaneous Coronary Intervention: Defining Coronary Responders

The effect of intra-aortic balloon counterpulsation (IABC) varies, and it is unknown whether this is due to a heterogeneous coronary physiological response. This study aimed to characterise the coronary and left ventricular (LV) effects of IABC and define responders in terms of their invasive physiology. Twenty-seven patients (LVEF 31 ± 9%) underwent coronary pressure and Doppler flow measurements in the target vessel and acquisition of LV pressure volume loops after IABC supported PCI, with and without IABC assistance. Through coronary wave intensity analysis, perfusion efficiency (PE) was calculated as the proportion of total wave energy comprised of accelerating waves, with responders defined as those with an increase in PE with IABC. The myocardial supply/demand ratio was defined as the ratio between coronary flow and LV pressure volume area (PVA). Responders (44.4%) were more likely to have undergone complex PCI (p = 0.03) with a higher pre-PCI disease burden (p = 0.02) and had lower unassisted mean arterial (87.4 ± 11.0 vs. 77.8 ± 11.6 mmHg, p = 0.04) and distal coronary pressures (88.0 ± 11.0 vs. 71.6 ± 12.4 mmHg, p < 0.001). There was no effect overall of IABC on the myocardial supply/demand ratio (p = 0.34). IABC has minimal effect on demand, but there is marked heterogeneity in the coronary response to IABC, with the greatest response observed in those patients with the most disordered autoregulation.

TCT-545 Defining Coronary Responders of Intra-aortic Balloon Pump Counterpulsation

The effect of intra-aortic balloon counterpulsation (IABC) varies and it is unknown whether this is due to a heterogeneous coronary physiological response. This study aims to characterise the coronary effects of IABC and identify the determinants of an increase in coronary perfusion efficiency (PE

Efficacy of intra-aortic balloon counterpulsation in patients with acute myocardial infarction according to the type of revascularization: a meta-analysis

To evaluate the effects of intra-aortic balloon counterpulsation (IABP) on mortality in patients with acute myocardial infarction according to the type of revascularization. Recruited randomized controlled trials of IABP compared with no-IABP controls in acute myocardial infarction patients from January 1970 to May 2015 were searched from Medline, Embase and Cochrane Library, according to inclusion criteria and exclusion criteria. These data were analyzed using the methods recommended by the Cochrane Collaboration's software RevMan 5.0. Revascularization included thrombolytic therapy, percutaneous coronary intervention (PCI), or coronary artery bypass grafting. (1) Eleven randomized controlled trials were enrolled for analysis with 1 102 patients in IABP group, 1 123 in no-IABP control group. (2) Compared with no-IABP control group, IABP could not significantly decrease the in-hospital or 30 day mortality (OR=0.84, 95%CI 0.65-1.09, P=0.20). (3)Compared with no-IABP control group, IABP could not significantly decrease the in-hospital or 30 day mortality in thrombolytic patients(OR=0.64, 95%CI 0.25-1.61, P=0.34), in PCI patients (OR=0.89, 95%CI 0.68-1.18, P=0.42), and in coronary artery bypass grafting patients(OR=0.46, 95%CI 0.13-1.63, P=0.23). (4)The difference reached borderline signiicance between no-IABP control group and IABP group in patients using IABP before PCI(OR=0.47, 95%CI 0.22-1.00, P=0.05), but not in case of after PCI(OR=1.33, 95%CI 0.63-2.79, P=0.45). IABP does not decrease the in-hospital or 30 day mortality of acute myocardial infarction patients who received thrombolytic therapy, PCI, or coronary artery bypass grafting. But IABP might decreases the in-hospital or 30 day mortality in patients when used before PCI.

Hemodynamic Effects of Intra-Aortic Balloon Counterpulsation in Patients with Advanced Heart Failure

Hemodynamic Effects of Intra-Aortic Balloon Counterpulsation in Patients with Advanced Heart Failure

The Early Benefit of Intra-Aortic Balloon Counterpulsation in Patients with Limited Pulse Pressure during Extracorporeal Life Support for Post-Cardiotomy Cardiogenic Shock

Objectives: Hemodynamically unstable cardiosurgical patients supported by an extracorporeal life support (ECLS) circuit empirically often receive additional intra-aortic balloon counterpulsation (IABP). This study aims to evaluate the effect of IABP on early outcome of ECLS for post-cardiotomy cardiogenic shock (PCS).

Extracorporeal life support for cardiogenic shock: influence of concomitant intra-aortic balloon counterpulsation

Intra-aortic balloon counterpulsation (IABP) during extracorporeal life support (ECLS) for cardiogenic shock may improve pulsatility and coronary perfusion, thereby promoting recovery of cardiac function. However, the risks and benefits of IABP during ECLS in real clinical settings have not been evaluated. This study aims to evaluate the effect of IABP on the early outcome of ECLS for cardiogenic shock. We evaluated 253 adult patients (aged 58.8 ± 15.3 [mean ± standard deviation] years, 154 males) undergoing ECLS for cardiogenic shock from January 2005 to August 2012. Of them, 60 patients underwent concomitant IABP (IABP group) and 193 underwent ECLS only (control group). In-hospital outcomes were compared using the inverse probability of treatment weighting based on propensity scores. The indications for ECLS were low cardiac output after cardiac surgery in 118 patients (46.6%), heart failure in 71 (28.1%), acute myocardial infarction in 49 (19.4%) and others in 15 (5.9%). Successful ECLS weaning rate was significantly higher in the IABP group than in the control group (61.7 vs 42.0%, P = 0.008); however, there was no significant difference in in-hospital mortality between the two groups (68.6 vs 72.0%, P = 0.58). After adjustment for propensity of treatment assignment conditional on baseline characteristics, the IABP group showed a decreased risk of weaning failure (odds ratio [OR] 0.51; 95% confidence interval [CI] 0.28-0.92, P = 0.024) but with a similar risk of in-hospital mortality (OR 0.85; 95% CI 0.46-1.60; P = 0.62) compared with the control group. The use of IABP during ECLS increased a successful ECLS weaning rate, but was not translated into improved survival. Studies on larger populations may verify the survival effect of IABP during ECLS.

The effects of intra-aortic balloon counterpulsation for valve replacement in patients with severe valvular heart disease

Objective To evaluate the effects of intra-aortic balloon pump (IABP) for valve replacement in patients with severe valvular heart disease.Methods The 60 patients with severe valvular heart disease who need surgical treatment were randomly divided into treated groups (n=30) and control group (n=30) with random digits table.The patients in treated group were inplanted with IABP preoperatively and cardiac resuscitated after operation.The patients in control group were not inplanted with IABP.The hemodynamic parameters in different time [time before anesthesia (T0),5 min after induction of anesthesia (T1),before cardio pulmonary bypass(T2),60 min after cardio pulmonary bypass(T3),the termination of cardio pulmonary bypass(T4),6 h after surgery(T5),12 h after surgery(T6),24 h after surgery(T7) 48 h after surgery(T8)] were recorded.During of T2-T8,urine volume was recorded and venous blood was extracted for quantifying the serum creatine kinase (CK),the creatine kinase-MB (CK-MB),cardiac troponin I (cTnI),lactic acid (Lac).Other parameters were also recorded.Results Parameters of mean artery pressure(MAP),heart rate (HR),central venous pressure (CVP),left atrial pressure (LAP) urine output,operation time,emergency cardiac care (ECC),cardiac resuscitation rate difference in treated group and control group were not significant different (P＞0.05) at each time point.Theplasma concentration of CKin at T5-Ts [(623±45),(432±34),(339±40),(252±21) U/L] and CK-MB [(172±37),(146±29),(122±29),(78±21) U/L] and cTnI [(48.84±7.73),(41.33±8.30),(30.80±6.42),(20.23±6.02) μg/L] and Lac [(3.1±0.8),(2.1:±0.9),(1.5±0.7),(1.2±0.5) mmol/L] in treated group were significantly lower than control group (P＜0.05).The consumption of dopamine[(7.2±2.1)μg·kg-1·min-1] and dobutamine [(7.2±2.1)μg·kg-1·min-1] after surgery were significantly reduced (P＜0.05),and the cases applied of adrenaline(0/30) were also significant reduced (P＜0.01) in treated group.The time of ventilation time [(18.3±7.6) h],time of ICU stayed [(4.8±1.2) d],hospitalization time after surgery (13.8±4.8) d and mortality (0/30) in treated group were lower than that in control group (P＜0.05).Conclusions Preoperative inplantation of IABP in patients with severe valvular heart disease during surgery of valve replacement could protect the myocardium,increased the survival of patients. Key words: Severe; Valvular heart disease; Intra-aortic balloon counterpulsation

TCT-446 Effect of Intra-Aortic Balloon Counterpulsation on Short-Term Survival in Cardiogenic Shock due to Acute Coronary Syndromes

To compare the outcome of percutaneous coronary intervention (PCI) treatment with intra-aortic balloon counterpulsation (IABP) versus PCI without IABP on 30-days survival in patients with cardiogenic shock (CS) due to acute coronary syndromes (STEMI and non-STEMI). We extracted data for all

293 * EXTRACORPOREAL LIFE SUPPORT FOR CARDIOGENIC SHOCK: INFLUENCE OF CONCOMITANT INTRA-AORTIC BALLOON COUNTERPULSATION

OBJECTIVES: Intra-aortic balloon counterpulsation (IABP) during extracorporeal life support (ECLS) for cardiogenic shock may improve pulsatility and coronary perfusion, thereby promoting recovery of cardiac function. However, the risks and benefits of IABP during ECLS in real clinical settings have not been evaluated. This study aims to evaluate the effect of IABP on the early outcome of ECLS for cardiogenic shock. METHODS: We evaluated 253 adult patients (aged 58.8 ± 15.3 [mean ± standard deviation] years, 154 males) undergoing ECLS for cardiogenic shock from January 2005 to August 2012. Of them, 60 patients underwent concomitant IABP (IABP group) and 193 underwent ECLS only (control group). In-hospital outcomes were compared using the inverse probability of treatment weighting based on propensity scores. RESULTS: The indications for ECLS were low cardiac output after cardiac surgery in 118 patients (46.6%), heart failure in 71 (28.1%), acute myocardial infarction in 49 (19.4%) and others in 15 (5.9%). Successful ECLS weaning rate was significantly higher in the IABP group than in the control group (61.7 vs 42.0%, P= 0.008); however, there was no significant difference in in-hospital mortality between the two groups (68.6 vs 72.0%, P= 0.58). After adjustment for propensity of treatment assignment conditional on baseline characteristics, the IABP group showed a decreased risk of weaning failure (odds ratio [OR] 0.51; 95% confidence interval [CI] 0.28–0.92, P= 0.024) but with a similar risk of in-hospital mortality (OR 0.85; 95% CI 0.46–1.60; P= 0.62) compared with the control group. CONCLUSIONS: The use of IABP during ECLS increased a successful ECLS weaning rate, but was not translated into improved survival. Studies on larger populations may verify the survival effect of IABP during ECLS.

Hemodynamic Effects of Intra-aortic Balloon Counterpulsation in Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock

We conducted the IABP Cardiogenic Shock Trial (ClinicalTrials.gov ID NCT00469248) as a prospective, randomized, monocentric clinical trial to determine the hemodynamic effects of additional intra-aortic balloon pump (IABP) treatment and its effects on severity of disease in patients with acute myocardial infarction complicated by cardiogenic shock (CS). Intra-aortic balloon pump counterpulsation is recommended in patients with CS complicating myocardial infarction. However, there are only limited randomized controlled trial data available supporting the efficacy of IABP following percutaneous coronary intervention (PCI) and its impact on hemodynamic parameters in patients with CS. Percutaneous coronary intervention of infarct-related artery was performed in 40 patients with acute myocardial infarction complicated by CS, within 12 h of onset of hemodynamic instability. Serial hemodynamic parameters were determined over the next 4 days and compared in patients receiving medical treatment alone with those treated with additional intra-aortic balloon counterpulsation. There were no significant differences among severity of disease (i.e., Acute Physiology and Chronic Health Evaluation II score) initially and no differences among both groups for disease improvement. We observed significant temporal improvements of cardiac output (4.8 ± 0.5 to 6.0 ± 0.5 L/min), systemic vascular resistance (926 ± 73 to 769 ± 101 dyn · s(-1) · cm(-5)), and the prognosis-validated cardiac power output (0.78 ± 0.06 to 1.01 ± 0.2 W) within the IABP group. However, there were no significant differences between the IABP group and the medical-alone group. Additional IABP treatment did not result in a significant hemodynamic improvement compared with medical therapy alone in a randomized prospective trial in patients with CS following PCI. Therefore, the use and recommendation for IABP treatment in CS remain unclear.

Effects of intra-aortic balloon counterpulsation in a model of septic shock*

Fluid refractory septic shock can develop into a hypodynamic cardiovascular state in both children and adults. Despite management of these patients with empirical inotropic therapy (with or without a vasodilator), mortality remains high. The effect of cardiovascular support using intra-aortic balloon counterpulsation was investigated in a hypodynamic, mechanically ventilated canine sepsis model in which cardiovascular and pulmonary support were titrated based on treatment protocols. Each week, three animals (n = 33, 10-12 kg) were administered intrabronchial Staphylococcus aureus challenge and then randomized to receive intra-aortic balloon counterpulsation for 68 hrs or no intra-aortic balloon counterpulsation (control). Bacterial doses were increased over the study (4-8 x 10(9) cfu/kg) to assess the effects of intra-aortic balloon counterpulsation during sepsis with increasing risk of death. Compared with lower bacterial doses (4-7 x 10(9) colony-forming units/kg), control animals challenged with the highest dose (8 x 10(9) colony-forming units/kg) had a greater risk of death (mortality rate 86% vs. 17%), with worse lung injury ([A - a]O2), and renal dysfunction (creatinine). These sicker animals required higher norepinephrine infusion rates to maintain blood pressure (and higher FIO2) and positive end-expiratory pressure levels to maintain oxygenation (p < or = 0.04 for all). In animals receiving the highest bacterial dose, intra-aortic balloon counterpulsation improved survival time (23.4 +/- 10 hrs longer; p = 0.003) and lowered norepinephrine requirements (0.43 +/- 0.17 microg/kg/min; p = 0.002) and systemic vascular resistance index (1.44 +/- 0.57 dynes/s/cm5/kg; p = 0.0001) compared with controls. Despite these beneficial effects, intra-aortic balloon counterpulsation was associated with an increase in blood urea nitrogen (p = 0.002) and creatinine (p = 0.12). In animals receiving lower doses of bacteria, intra-aortic balloon counterpulsation had no significant effects on survival or renal function. In a canine model of severe septic shock with a low cardiac index, intra-aortic balloon counterpulsation prolongs survival time and lowers vasopressor requirements.

Invited Commentary

In the article by Takami and Masumoto [1], the hemodynamic effects of intra-aortic balloon counterpulsation (IABC) on graft flow in coronary artery bypass grafts (CABGs) was studied using transit-time flowmetric measurements. There are so few studies addressing this important issue, and the authors are to be congratulated for a solid and well-performed clinical study. The authors have convincingly demonstrated that IABC significantly increases global graft flow in various types of conduits, such as saphenous vein grafts, radial artery, gastroepiploic artery, and internal thoracic arteries.

Early and sustained haemodynamic improvement with levosimendan compared to intraaortic balloon counterpulsation (IABP) in cardiogenic shock complicating acute myocardial infarction

To investigate the haemodynamic effects of levosimendan in patients with cardiogenic shock (CS) complicating acute myocardial infarction in comparison to the effects of intra-aortic balloon counterpulsation (IABP). 10 patients with intractable CS under standard therapy (including the use of PCI, inotropes, and vasopressors) received i.v. infusion of levosimendan (bolus 12 microg/kg i.v., followed by continuous infusion 0.1 microg/kg/min for 24 h). Haemodynamic effects were compared to the effects of IABP-placement added to standard care in 12 patients with CS. Within 24 h, both levosimendan and IABP produced a significant increase in cardiac index (CI) and cardiac power index and a decrease in systemic vascular resistance (SVR) (CI [l/min/m2] baseline 1.97+/-0.15, at 24 h 2.82+/-0.22 for levosimendan; baseline 1.98+/-0.17, at 24 h 2.66+/-0.08 for IABP; SVR [dyn*s*cm-5] baseline 1353+/-106, at 24 h 846+/-69 for levosimendan; baseline 1311+/-214, at 24 h 853+/-63 for IABP, respectively). After 3 h of treatment, CI and SVR had significantly improved in patients treated with levosimendan but not in the IABP-group (CI [l/min/m2] at 3 h 2.72+/-0.28 (+38%) for levosimendan versus 2.18+/-0.15 (+10%) for IABP). Infusion of levosimendan in acute CS results in early and sustained haemodynamic improvement. Short-term haemodynamic effects compare favourably with those seen after invasive IABP placement.

Effects of intra-aortic balloon counterpulsation on coronary pressure in patients with stenotic coronary arteries

The benefits of intra-aortic balloon pumping (IABP) usage reportedly occur through systolic unloading of the left ventricle and the augmentation of diastolic coronary flow. The aim of this study was to assess the change in intracoronary pressure distal to the coronary stenosis after the IABP by using an intracoronary pressure wire. Hemodynamic variables and intracoronary pressure data were measured in 16 patients requiring IABP for clinical indication (11 vessels with coronary stenosis and 5 normal vessels were enrolled). Coronary pressure was measured directly in each vessel with and without IABP support. The diastolic aortic pressure during IABP increased compared with that without the IABP (97.9 +/- 11.7 vs 80.3 +/- 10.7 mm Hg, P < .01). The systolic aortic and intracoronary pressure during the IABP decreased (aortic pressure: 83.8 +/- 10.4 vs 95.9 +/- 11.3 mm Hg, P < .01, intracoronary pressure: 67.6 +/- 16.5 vs 76.2 +/- 20.4 mm Hg, P < .01). The diastolic distal coronary pressure (Pd) increased during the IABP in healthy coronary arteries (87.3 +/- 4.8 vs 72.1 +/- 10.3 mm Hg, P < .05). However, Pd in stenotic coronary arteries with the IABP did not increase statistically compared with those without the IABP (44.0 +/- 21.3 vs 42.8 +/- 17.9 mm Hg). There was a significant correlation between the change in Pd after IABP insertion and percent diameter stenosis calculated by quantitative coronary angiography (r2 = 0.51, P < .001). In the presence of a critical coronary stenosis, the IABP does not increase the diastolic coronary pressure distal to the stenosis. Thus, the major effect of IABP on high-risk patients with severe coronary stenosis may relate to the reduction of oxygen demand by systolic unloading more than diastolic augmentation of the coronary flow.

The effect of intra-aortic balloon counterpulsation on left ventricular functional recovery early after acute myocardial infarction: a randomized experimental magnetic resonance imaging study

We sought to determine whether intra-aortic balloon pump (IABP) counterpulsation improves the recovery of left ventricular (LV) systolic function after reperfused acute myocardial infarction (AMI). Fourteen dogs underwent 90-min coronary artery occlusion followed by reperfusion. Seven animals were randomized to IABP counterpulsation immediately after reperfusion. Tagged, cine, and contrast-enhanced magnetic resonance imaging were used for regional and global LV functional assessment and MI characterization, respectively. Image acquisition was performed at 1 h, 6 h, and 24 h after reperfusion, during which the IABP device was paused. Animals randomized to IABP demonstrated an earlier improvement of LV ejection fraction when compared with controls (25+/-3 vs. 25+/-2% at 1 h, P=0.91; 36+/-3 vs. 26+/-2% at 6 h, P=0.015; and 38+/-3 vs. 35+/-1% at 24 h, P=0.34). Regional functional analyses revealed the same behaviour among non-infarcted risk regions, i.e., earlier circumferential systolic strain improvement in the IABP group than in controls (-5.4+/-0.4 vs. -5.3+/-0.5% at 1 h, P=0.86; -12.1+/-1.0 vs. -6.0+/-0.4% at 6 h, P<0.001; and -13.9+/-1.1% vs. -12.8+/-0.6% at 24 h, P=0.40). Importantly, however, the degree of LV functional recovery 24 h after reperfusion was similar whether IABP counterpulsation was used or not. IABP counterpulsation accelerates but does not significantly improve the recovery of LV systolic function after reperfused AMI.

Arterial compliance is a main variable determining the effectiveness of intra-aortic balloon counterpulsation: quantitative data from an in vitro study

Quantitative data concerning the effect of arterial compliance (AC) on the effectiveness of intra-aortic balloon counterpulsation (IABC) are lacking. The main objective of this study was to investigate the relationship between AC and IABC performance. For this purpose we constructed a Windkessel, lumped-element, hydraulic model of the systemic circulation. The model consisted of a left ventricular assist device (LVAD), a compliance chamber, a peripheral resistor and two open reservoirs. Two Datascope Driving systems were used to operate the LVAD and intra-aortic balloon. We studied the effect of arterial compliance on the effectiveness of IABC at different levels of mean pressure (55, 75 and 95 mmHg) and heart rates (80, 100, 120 bpm). Three indices were used to evaluate IABC performance: the reduction of systolic and end-diastolic “arterial” pressure and the augmentation of diastolic pressure, induced by the IABC. A 22% decrease in AC (1.8–1.4 ml/mmHg) lead to a 30–40% increase in the indices of IABC performance, independently from pressure. In conclusion, arterial compliance significantly affects IABC efficacy and it could be considered as a further clinical criterion to decide IABC application.

Renal effects of intra-aortic balloon counterpulsation and of the Hemopump

The intra-aortic balloon pump (IABP) and the Hemopump are important techniques for acute mechanical support of the ischemic or failing heart in the intensive care unit. These techniques can have significant effects on the kidneys of critically ill patients. The beneficial effects of IABP support, however, depend entirely on improvement in the systemic circulation. If no improvement occurs, no benefit is conferred on renal function. Harmful effects may occur as a result of vascular complications and include renal failure secondary to rhabdomyolysis, atheroembolism, aortic or renal artery thrombosis, renal artery obstruction, aortic dissection, and catheter-related sepsis. The Hemopump has the capacity of augmenting cardiac output much more effectively than the IABP and is a form of left ventricular assist device. By restoring cardiac output to normal levels in patients with acute severe left ventricular failure, it can significantly improve renal blood flow. The centrally (ascending aorta) inserted 24-F Hemopump is likely to induce fewer vascular complications than the peripherally inserted IABP. It is also likely to improve cardiac output much more than what can be achieved with the IABP and also achieves better renal blood flow augmentation in patients with postbypass cardiogenic shock.

Effect of intraaortic balloon counter-pulsation on QT dispersion in acute anterior myocardial infarction

The present prospective non-randomized study aimed to examine whether intraaortic balloon counter-pulsation (IABP) has a favorable effect on QT dispersion in patients with acute anterior MI. Patients with acute anterior MI who presented within 6 h after the symptom onset were assigned to the IABP+streptokinase or streptokinase (STK) group. The IABP+STK group was consisted of 26 men and two women (mean age 52.9±10.2). The STK group was consisted of 19 men and two women (mean age 54.4±10.8). In the IABP+STK group, mean QT interval dispersion significantly shortened 6 h after treatment (50.9±15.6 ms before STK, and 36±13.9 ms 6 h after STK; P=0.001) and did not significantly change 24 h after STK (35.6±11.2 ms). In the STK group, mean QT interval dispersion did not vary significantly before and 6 h after STK (57.14±13.2 ms before STK, and 56.07±13.3 ms 6 h after STK; P>0.05) but 24 h after STK it significantly shortened to 40.42±10.8 ms ( P<0.001). Before STK, mean QT interval dispersions in the IABP+STK and STK groups were 50.9±15.6 ms and 57.14±13.2 ms, respectively ( P>0.05), 6 h after STK, mean QT interval dispersions were 36±13.9 ms and 56.07±13.3 ms, respectively ( P=0.0001) and 24 h after STK, mean QT interval dispersions were 35.6±11.2 ms and 40.42±10.8 ms, respectively ( P>0.05). In conclusion this study demonstrates that the adjunct of IABP to thrombolytic therapy, in the setting of acute anterior MI, significantly decreases QT interval dispersion at 6 h and this effect might be secondary to accelerated reperfusion and/or other beneficial effects of IABP.