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CLINICAL RESEARCH: ULTRASOUND IMAGING IN CORONARY DISEASE

Enhanced coronary flow velocity during intra-aortic balloon pumping assessed by transthoracic doppler echocardiography

Masaaki Takeuchi, MD^*,*, Yuichi Nohtomi, MD, Hidetoshi Yoshitani, MD^*, Chinami Miyazaki, MD^*, Kazuo Sakamoto, MD^* and Junichi Yoshikawa, MD

^* Department of Internal Medicine, Tane General Hospital, Osaka, Japan
Department of Cardiology, Iizuka Hospital, Fukuoka, Japan
Department of Internal Medicine and Cardiology, Graduate School of Medicine, Osaka City University, Osaka, Japan

Manuscript received May 7, 2003; revised manuscript received August 6, 2003, accepted August 26, 2003.

^* Reprint requests and correspondence: Dr. Masaaki Takeuchi, Department of Internal Medicine, Tane General Hospital, 1-2-31 Sakaigawa, Nishi-ku, Osaka, 550-0024 Japan.
masaaki_takeuchi{at}hotmail.com

OBJECTIVES: The study was done to determine potential utility of measuring coronary flow velocity (CFV) by transthoracic Doppler echocardiography (TTDE) during intra-aortic balloon pumping (IABP).

BACKGROUND: Use of IABP has been shown to increase CFV assessed by an invasive technique. The CFV in the left anterior descending coronary artery (LAD) can be measured by TTDE.

METHODS: Coronary flow velocity in the distal LAD by TTDE was measured in 40 critically ill patients requiring IABP. All patients received emergency coronary angiography. Both CFV and pressure data were obtained during 1:2 balloon pumping.

RESULTS: Adequate diastolic CFV recording was obtained in all patients. The IABP decreased systolic pressure and increased diastolic pressure. Average peak diastolic flow velocity and diastolic velocity time integral was 19 ± 11 cm/s and 7.7 ± 4.4 cm with non-augmented beat. These values were increased significantly (61 ± 38%, 59 ± 35%, p < 0.001) with augmented beat. Significant correlation was noted between % diastolic pressure augmentation and % increase in diastolic CFV (r = 0.62 to 0.69, p < 0.001). There was no significant difference in flow enhancement during IABP, irrespective to the proximal LAD stenosis severity (severe stenosis: 73 ± 70%; intermediate stenosis: 61 ± 29%; no significant stenosis: 58 ± 29%; p = NS, analysis of variance). By continuous recording of CFV, the optimal timing of balloon control could be adjusted to maximize flow velocity during augmentation.

CONCLUSIONS: Use of TTDE can be employed in monitoring CFV augmentation during IABP. The IABP produced significant distal flow enhancement even in patients with critical proximal stenosis. This totally noninvasive approach may help to optimize the benefits of IABP for coronary flow augmentation.

Abbreviations and Acronyms   APDV = time-averaged peak diastolic velocity   APSV = time-averaged peak systolic velocity   BP = blood pressure   CFV = coronary flow velocity   DFVI = diastolic flow velocity integral   IABP = intra-aortic balloon pumping   LAD = left anterior descending coronary artery   MI = myocardial infarction   QCA = quantitative coronary angiography   SFVI = systolic flow velocity integral   TIMI = Thrombolysis In Myocardial Infarction   TTDE = transthoracic Doppler echocardiography

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