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CLINICAL RESEARCH: PRECLINICAL STUDY

Reduction of "no-reflow" phenomenon by intra-aortic balloon counterpulsation in a randomized magnetic resonance imaging experimental study

Luciano C. Amado, MD^*, Dara L. Kraitchman, VMD, PhD, Bernhard L. Gerber, MD^*, Ernesto Castillo, MD, Raymond C. Boston, PhD, Joseph Grayzel, MD and João A. C. Lima, MD, FACC^*,*

^* Department of Medicine, Division of Cardiology, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania, USA
Datascope Corporation, Mahwah, New Jersey, USA

Manuscript received August 18, 2003; revised manuscript received November 3, 2003, accepted November 18, 2003.

^* Reprints requests and correspondence: Dr. João A. C. Lima, Cardiology Division (Blalock 524), Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, Maryland 21287-6568, USA.
jlima{at}jhmi.edu

OBJECTIVES: Intra-aortic balloon counterpulsation (IABC) can improve post-myocardial infarction (MI) outcomes, but the mechanisms of such effect remain unclear. We hypothesized that IABC augmentation reduces the extent of microvascular obstruction after acute infarction.

BACKGROUND: Microvascular obstruction or "no-reflow" (MO) has been shown to negatively influence left ventricular (LV) remodeling after myocardial infarction (MI).

METHODS: Seventeen dogs underwent 90 min of coronary artery occlusion followed by reperfusion. Animals were then randomized to either IABC (n = 9) or control (n = 8); IABC augmentation was performed for 24 h after MI. Microvascular obstruction and infarct size by first-pass and delayed contrast-enhanced magnetic resonance imaging (MRI) were measured at 1 and 24 h after reperfusion and compared with postmortem infarct size and MO by microspheres.

RESULTS: Microvascular obstruction by MRI, expressed as percent LV mass, decreased significantly in IABC (4.9 ± 2.2% to 3.6 ± 1.5%) and increased in controls (3.4 ± 0.5% to 4.9 ± 1.1% from 1 to 24 h, respectively; p < 0.001). Similar results were found for MO defined by microspheres. In the control group, MO increased significantly, during 24 h of study (from 8.8 ± 1.7% to 43.2 ± 11.1% of infarcted myocardium; p < 0.05), whereas not important change was observed in the IABC group (from 21.3 ± 7.1% to 25.8 ± 14.7%; p < 0.05 vs. control at 24 h). Infarct size, measured by MRI, increased in both groups (13.2 ± 1.8 to 15.5 ± 2.1 from 1 to 24 h, respectively; p < 0.05).

CONCLUSIONS: Intra-aortic balloon counterpulsation augmentation performed after reperfusion improves myocardial perfusion at the tissue level, and reduces the extent of no-reflow caused by microvascular obstruction.

Abbreviations and Acronyms   IABC = intra-aortic balloon counterpulsation   LV = left ventricle/ventricular   MBF = myocardial blood flow   MI = myocardial infarction   MO = microvascular obstruction or "no-reflow phenomenon"   MRI = contrast-enhanced magnetic resonance imaging   TTC = 2,3,5-triphenyltetrazolium chloride

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