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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

View larger version (15K): [in a new window]   Figure 1 Comparison of first-pass magnetic resonance imaging (MRI) hypoenhancement (i.e., no-reflow) and microsphere blood flow <50% relative to remote-region blood flow (A) at 1 and (B) 24 h after reperfusion. Values are normalized to left ventricular (LV) mass.

View larger version (63K): [in a new window]   Figure 2 Short-axis magnetic resonance imaging (top) demonstrating infarct location and extent as a hyperenhancing region compared with postmortem 2,3,5-triphenyltetrazolium chloride-staining in a representative animal.

View larger version (11K): [in a new window]   Figure 3 Comparison of infarct size measured by delayed magnetic resonance imaging (MRI) and postmortem analysis with 2,3,5-triphenyltetrazolium chloride (TTC) staining 24 h after reperfusion. LV = left ventricle.

View larger version (152K): [in a new window]   Figure 4 Short-axis magnetic resonance image demonstrating example of animals in both groups. (A) A decrease in no-reflow extent in an intra-aortic balloon counterpulsation animal at 1 (left) and 24 h (right) after reperfusion. (B) An increase in no-reflow extent in a control animal at same time points.

View larger version (22K): [in a new window]   Figure 5 Change in microvascular obstruction (MO) between the intra-aortic balloon counterpulsation (IABC) (n = 9) and control (n = 8) groups from 1 to 24 h after reperfusion: (A) In the control group, MO increases over time, while in the IABC, MO decreases over 24 h (p < 0.001). Grey bars = control; black bars = IABC. (B) At 24 h of study period, an increase of 60 ± 22% on the control group was observed (as percent left ventricular mass), while, with intra-aortic balloon augmentation, a decrease of 10 ± 10% was noted. (C) Change in MO, evaluated as areas with myocardial blood flow (MBF) <50% of the remote given as percent of infarcted region. In the control group, MO increases over time, while, in the IABC, no important change is observed (p < 0.05 vs. control at 24 h). NR = no-reflow.

View larger version (23K): [in a new window]   Figure 6 Infarct expansion measured by delayed magnetic resonance imaging (MRI) in intra-aortic balloon counterpulsation (IABC) (n = 9) and control (n = 8) animals increased over 24 h of reperfusion in both groups (p < 0.03). Infarct expansion was decreased in IABC relative to controls (p < 0.04). p < 0.04 vs. control. LV = left ventricular.