Beat-to-Beat Effects of Intraaortic Balloon Pump Timing on Left Ventricular Performance in Patients With Low Ejection Fraction Jan J. Schreuder, MD,

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Presentation transcript:

Beat-to-Beat Effects of Intraaortic Balloon Pump Timing on Left Ventricular Performance in Patients With Low Ejection Fraction Jan J. Schreuder, MD, PhD, Francesco Maisano, MD, Andrea Donelli, MS, Jos R.C. Jansen, PhD, Pat Hanlon, RN, Jan Bovelander, CRNA, Ottavio Alfieri, MD The Annals of Thoracic Surgery Volume 79, Issue 3, Pages 872-880 (March 2005) DOI: 10.1016/j.athoracsur.2004.07.073 Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Effects of regular 1:1 IABP initiation (arrows), with IAB inflation performed near the dicrotic notch of the Pao and deflation effecting decrease in end-diastolic Pao in patient A (NYHA III, EF 14%) and patient B (NYHA III, EF 22%). IABP induced acute stroke volume increases by decreasing LV end-systolic pressure (P) and volume (V), delineating nonlinear Ees (dotted lines) followed by end-diastolic P-V decreases. Numbers 1–10 represent first 10 beats after IABP initiation. (Ees = end-systolic elastance; EF = ejection fraction; IABP = intraaortic balloon pump; LV = left ventricular; NYHA = New York Heart Association; Pao = mean aortic pressure; PLV = left ventricular pressure; VLV = left ventricular volume.) The Annals of Thoracic Surgery 2005 79, 872-880DOI: (10.1016/j.athoracsur.2004.07.073) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Premature IAB inflation (A) applied 150 ms (arrows, b) before the dicrotic notch of the aortic pressure (Pao) generated abrupt increases in LV afterload in late ejection with impairment of LV volume (VLV) ejection in NYHA II patient (EF 33%). Late IAB deflation (B) increased end-diastolic Pao (arrows, b) and increased afterload during early ejection (c) followed by decreased afterload in late ejection increasing stroke volume in NYHA III patient (EF 24%); a, b, and c represent beats analyzed according to Tables 2 and 3. (EF = ejection fraction; LV = left ventricular; NYHA = New York Heart Association; PLV = left ventricular pressure.) The Annals of Thoracic Surgery 2005 79, 872-880DOI: (10.1016/j.athoracsur.2004.07.073) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Five LV segmental volume tracings (s1-s5) and TVLV used for Dys analysis in patient A (Fig 1). Pronounced paradoxical segmental volume movements are located in the apex (s1-s2). The calculated Dys decreased immediately after initiation of IABP at a 1:1 ratio (arrow). (Dys = dyssynchrony; IABP = intraaortic balloon pump; LV = left ventricular; TVLV = total volume tracing.) The Annals of Thoracic Surgery 2005 79, 872-880DOI: (10.1016/j.athoracsur.2004.07.073) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 (A, B) Regression diagrams from IABP at 1:1 assist ratio and from (C) early/late IAB inflation/deflation at 1:4 assist ratio demonstrating: (A) percent change in SV (%ΔSV) versus LV TDys (ΔTDys); (B) %ΔSV versus Ees; and (C) %ΔSV versus change in systolic dyssynchrony (ΔSysDys). Dotted lines represent 95% prediction limits. (Ees = end-systolic elastance; IABP = intraaortic balloon pump; LV = left ventricular; SV = stroke volume; TDys = total dyssynchrony.) The Annals of Thoracic Surgery 2005 79, 872-880DOI: (10.1016/j.athoracsur.2004.07.073) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions