Advertisement

Basic Research in Cardiology

, Volume 69, Issue 4, pp 379–401 | Cite as

The response of mechanical performance, coronary blood flow and myocardial oxygen consumption of the normal and failing dog heart to intraaortic balloon pulsation

  • W. Bleifeld
  • G. Franken
  • J. Meyer
  • W. -D. Bussmann
Article

Summary

Circulatory hemodynamics, coronary blood flow and myocardial oxygen consumption were studied in 10 open chest dogs in chloralose-urethan anesthesia during intraaortic balloon-pulsation (IABP).

In the normal heart (10 dogs) 10 min IABP resulted in a significant decrease of left ventricular mean systolic pressure for 13% (p<0.001) of dp/dtmax for 5% (NS) and of tension time index for 15% (p<0.001), whereas stroke volume and mean arterial pressure were unchanged. Coronary blood flow followed the alterations of arterial pressure with a decline of systolic and an increase of diastolic left circumflex coronary flow in the presence of unaltered mean coronary blood flow during diastolic augmentation. Myocardial oxygen consumption was reduced for 8% on the average as an effect of the unloading of the left ventricle by IABP.

Cardiogenic shock with hypotension, low stroke volume, cardiac output and coronary blood flow was simulated by serial ligation of coronary arteries. In contrast to the normotensive circulatory state IABP effected in this shock state an increase of left ventricular mean systolic pressure for 19%, mean arterial pressure for 31% (p<0.05) and mean left circumflex coronary blood flow for 37% (p<0.02) after 30 min. Myocardial oxygen consumption increased modestly for 15% (NS) after 10 min IABP compared to the shock state.

The different results in the sufficient and insufficient heart can be explained by the response of the baroreceptors in various pressure ranges to the phaseshift of the arterial pulse.

Keywords

Cardiogenic Shock Coronary Blood Flow Versus Versus Versus Versus Myocardial Oxygen Consumption Coronary Perfusion Pressure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Hämodynamik, Koronardurchblutung und myokardialer Sauerstoffverbrauch des normalen und insuffizienten Hundeherzens unter intraaortaler Ballonpulsation

Zusammenfassung

An 10 Hunden wurden die linksventrikuläre Hämodynamik, Koronardurchblutung und der Sauerstoffverbrauch des Herzens während intraaortaler Ballonpulsation (IABP) untersucht.

Beim suffizienten Herzen (10 Hunde) führte 10 min IABP zu einem signifikanten Abfall des mittleren systolischen Druckes im linken Ventrikel von 13% (p<0,001), von dp/dtmax um 5% (NS) und des „tension time index” um 15% (p<0,001), während Schlagvolumen und mittlerer arterieller Druck unverändert blieben. Die Koronardurchblutung wurde parallel zum arteriellen Druck verändert: Während der systolische Fluß im Ramus circumflexus der linken Kranzarterie abfiel und der diastolische Fluß anstieg, blieb die mittlere Koronardurchblutung unverändert. Als Folge der systolischen Druckentlastung des linken Ventrikels fiel der myokardiale Sauerstoffverbrauch um 8%.

Ein Schockzustand mit erniedrigtem arteriellem Blutdruck, Herzminutenvolumen und Koronardurchblutung wurde durch Serienligatur von Koronararterienästen herbeigeführt. Im Gegensatz zum normotonen Kreislaufzustand führte 30 min IABP beim kardiogenen Schock zu einem Anstieg des mittleren systolischen Druckes im linken Ventrikel von 19%, des mittleren arteriellen Druckes von 31% (p<0,05) und der mittleren Koronardurchblutung von 37% (p<0,02). Dabei stieg der myokardiale Sauerstoffverbrauch um 15% (NS).

Die unterschiedlichen Auswirkungen der IABP auf die Hämodynamik und Koronardurchblutung des linken Ventrikels lassen sich erklären aufgrund der Reaktion der Barorezeptoren, der Veränderungen der Pulsform während IABP in verschiedenen Druckbereichen.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Meesmann, W., Untersuchungen zur Pathophysiologie und Therapie des Herzinfarktes. Arch. Kreislaufforschg.36, 212 (1961).CrossRefGoogle Scholar
  2. 2.
    Dissmann, W., H. J. Buschmann, V. Meyer, W. Thimme, R. Schröder, Haemodynamische Veränderungen nach akutem Myokardinfarkt. Klin. Wschr.45, 801 (1967).CrossRefPubMedGoogle Scholar
  3. 3.
    Ratshin, R. A., Ch. E. Rackley, R. O. Russell jr., Hemodynamic evaluation of left ventricular function in shock complicating myocardial infarction. Circulation45 127 (1972).CrossRefPubMedGoogle Scholar
  4. 4.
    Agress, C. M., M. J. Binder, Cardiogenic shock. Amer. Heart J.,54, 458 (1957).CrossRefPubMedGoogle Scholar
  5. 5.
    Griffith, G. C., W. B. Wallace, B. Cochran jr.,W. E. Nerlich, W. G. Frasher, The treatment of shock associated with myocardial infarction. Circulation9, 527 (1954).CrossRefPubMedGoogle Scholar
  6. 6.
    Lown, B., C. Vassaux, W. B. Hood jr.,A. M. Fakhro, E. Kaplinski, G. Roberge, Unresolved problems in coronary care. Amer. J. Cardiol.20, 494 (1967).CrossRefPubMedGoogle Scholar
  7. 7.
    Braunwald, E., Control of myocardial oxygen consumption. Amer. J. Cardiol.27, 416 (1971).CrossRefPubMedGoogle Scholar
  8. 8.
    Graham, Th. P. jr.,J. W. Covell, E. H. Sonnenblick, J. Ross jr.,E. Braunwald, Control of myocardial oxygen consumption: Relative influence of contractile state and tension development. J. Clin. Invest.47, 375 (1968).CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Sonnenblick, E. H., J. Ross jr.,E. Braunwald, Oxygen consumption of the hart-newer concepts of its multifactorial determination. Amer. J. Cardiol.22, 328 (1968).CrossRefPubMedGoogle Scholar
  10. 10.
    Bleifeld, W., Assistierte Zirkulation. Dtsch. Med. Wschr.95, 775 (1970).CrossRefPubMedGoogle Scholar
  11. 11.
    Kantrowitz, A. R., P. N. Madras, J. D. Laird, R. T. Jones, W. G. Austen, M. J. Buckley, Cardiac assistance by the intraaortic balloon. 2nd Medical Physics Conference, Boston, Mass., 13th August 1969.Google Scholar
  12. 12.
    Talpins, N. L., D. C. Kripke, R. H. Goetz, Counterpulsation and intraaortic balloon pumping in cardiogenic shock. Arch. Surg.97, 991 (1968).CrossRefPubMedGoogle Scholar
  13. 13.
    Brown, B. G., D. Goldfarb, S. R. Topaz, V. L. Gott, Diastolic augmentation by intraaortic balloon. J. Thorac. Cardiovasc. Surg.53, 789 (1967).PubMedGoogle Scholar
  14. 14.
    Feola, M., O. Haiderer, J. H. Kennedy, Intraaortic balloon pumping (IABP) at different levels of experimental acute left ventricular failure. Chest Dis.59, 68 (1971).CrossRefGoogle Scholar
  15. 15.
    Hirsch, C. J., S. Lluch, L. N. Katz, Counterpulsation effects of coronary blood flow and cardiac oxygen utilisation. Circulat. Res.19, 1031 (1966).CrossRefPubMedGoogle Scholar
  16. 16.
    Lefemine, A. A., H. B. C. Low, M. L. Cohen, St. Lunzer, D. E. Harken, The effect of synchronized arterial counterpulsation on myocardial oxygen consumption and coronary flow. Amer. Heart J.64, 789 (1962).CrossRefPubMedGoogle Scholar
  17. 17.
    Powell, W. J. jr.,W. M. Dagett, A. E. Magro, J. A. Bianco, M. J. Buckley, Ch. A. Sanders, A. R. Kantrowitz, Effects of intraaortic balloon counterpulsation on cardiac performance, oxygen consumption and coronary blod flow in dogs. Circulat. Res.26, 753 (1970).CrossRefPubMedGoogle Scholar
  18. 18.
    Soroff, H. S., H. J. Levine, B. F. Sachs, W. C. Birtwell, R. A. Deterling jr., Assisted circulation II: Effects of counterpulsation on left ventricular oxygen consumption and hemodynamics, Circulation27, 722 (1963).CrossRefGoogle Scholar
  19. 19.
    Spotnitz, H. M., J. W. Covell, J. Ross jr. et al., Left ventricular mechanics and oxygen consumption during arterial counterpulsation. Amer. J. Physiol.217, 1352 (1969).PubMedGoogle Scholar
  20. 20.
    Tanaka, S., W. Rassmann, A. Landé, R. Kaster, C. W. Lillehei, Cardiovascular response of the failing dog heart to counterpulsation. J. Thorac. Cardiovasc. Surg.58, 112 (1969).PubMedGoogle Scholar
  21. 21.
    Yahr, W. J., A. N. Butner, J. S. Krakauer, St. J. Phillips, P. S. Freed, D. Jaron, A. Kantrowitz, Intraaortic phase-shift balloon pumping in cardiogenic shock: Laboratory and clinical observations. Med. Ann. Distr. Col.38, 237 (1969).Google Scholar
  22. 22.
    Irnich, W., W. Bleifeld, H. J. Bisping, Realization of a high-speed balloon-pulsation system. Digest of the 9th International Conference on Medical and Biological Engineering Melbourne, p. 198, 1971.Google Scholar
  23. 23.
    Gleichmann, U., D. W. Lübbers, Die Messung des Sauerstoffdruckes in Gasen und Flüssigkeiten unter besonderer Berücksichtigung der Messung im Blut. Pflügers Arch. ges. Physiol.271, 431 (1960).CrossRefGoogle Scholar
  24. 24.
    Bartels, H., H. Harms, Sauerstoffdissoziationskurven des Blutes von Säugetieren. Pflügers Arch. ges. Physiol.268, 334 (1959).CrossRefGoogle Scholar
  25. 25.
    Allela, A., F. L. Williams, C. Bolene-Williams, L. N. Katz, Interrelation between cardiac oxygen consumption and coronary blood flow. Amer. J. Physiol.183, 570 (1955).Google Scholar
  26. 26.
    Braunwald, E., S. J. Sarnoff, R. B. Case, W. N. Stainsby, G. H. Welch jr., Hemodynamic determinants of coronary flow: Effect of changes in aortic pressure and cardiac output on the relationship between myocardial oxygen consumption and coronary flow. Amer. J. Physiol.192, 157 (1958).PubMedGoogle Scholar
  27. 27.
    Feinberg, H., A. Gerola, L. N. Katz, Effect of hypoxia on cardiac oxygen consumption and coronary flow. Amer. J. Physiol.195, 593 (1958).PubMedGoogle Scholar
  28. 28.
    Feinberg, H., L. N. Katz, E., Boyd, Determinants of coronary flow and myocardial oxygen consumption. Amer. J. Physiol.202, 45 (1962).PubMedGoogle Scholar
  29. 29.
    Mosher, P., J. Ross jr.,P. A. McFate, R. F. Shaw, Control of coronary blood flow by an autoregulatory mechanism. Circulat. Res.14, 250 (1964).CrossRefPubMedGoogle Scholar
  30. 30.
    Arnold, G., F. Kosche, E. Miessner, A. Neitzert, W. Lochner, The importance of the perfusion pressure in the coronary arteries for the contractility and the oxygen consumption of the heart. Pflügers Arch. ges. Physiol.229, 339 (1968).CrossRefGoogle Scholar
  31. 31.
    Arnold, G., C. Morgenstern, W. Lochner, S. Oswald, The autoregulation of heart work by the coronary perfusion pressure. Pflügers Arch. ges. Physiol.321, 34 (1970).CrossRefGoogle Scholar
  32. 32.
    Sugimoto, T., K. Sagawa, A. C. Guyton, Quantitative effect of low coronary pressure on left ventricular performance. Jap. Heart J.9, 46 (1968).CrossRefPubMedGoogle Scholar
  33. 33.
    Sonnenblick, E. H., C. L. Skelton, Myocardial energetics: Basic principles and clinical implications. New Engl. J. Med.285, 668 (1971).CrossRefPubMedGoogle Scholar
  34. 34.
    Norman, N. A., J. H. Kennedy, Arterial baroreceptor responses to intraaortic balloon assistance. J. Surg. Res.11, 396 (1971).CrossRefGoogle Scholar
  35. 35.
    Brown, B. G., D. Goldfarb, V. L. Gott, A vasomotorreflex contribution to systolic pressure reduction during diastolic augmentation. Trans. Amer. Soc. Artif. Int. Organs12, 63 (1966).Google Scholar
  36. 36.
    Sarnoff, S. J., E. Braunwald, G. H. Welch jr.,R. B. Case, W. N. Stainsby, R. Macruz, Hemodynamic determinants of oxygen consumption of the heart with special reference to the tension-time-index. Amer. J. Physiol.192, 148 (1958).PubMedGoogle Scholar
  37. 37.
    Guyton, A. C., Circulatory physiology: Cardiac output and his regulation (Philadelphia and London 1963).Google Scholar
  38. 38.
    Heymans, C., E. Neil, Reflexogenic areas of the cardiovascular system (Boston 1958).Google Scholar
  39. 39.
    Gregg, D. E., Effect of coronary perfusion pressure or coronary flow on oxygen uptake of the myocardium. Circulat. Res.13, 497 (1963).CrossRefPubMedGoogle Scholar
  40. 40.
    Kahler, R. L., E. Braunwald, L. L. Kelminson, L. Kedes, Ch. A. Chidsey, St. Segal, Effect of alterations of coronary blood flow on the oxygen consumption of the nonworking heart. Circulat. Res.13, 501 (1963).CrossRefPubMedGoogle Scholar
  41. 41.
    Ross, J. jr.,F. Klocke, G. Kaiser, E. Braunwald, Effect of alterations of coronary blood flow on the oxygen consumption of the working heart. Circulat. Res.13, 510 (1963).CrossRefPubMedGoogle Scholar
  42. 42.
    Sarnoff, S. J., J. P. Gilmore, N. S. Skinner jr.,A. G. Wallace, J. H. Mitchell, Relation between coronary blood flow and myocardial oxygen consumption. Circulat. Res.13, 514 (1963).CrossRefPubMedGoogle Scholar
  43. 43.
    Weisberg, H., L. N. Katz, E. Boyd, Influence of coronary blood flow upon oxygen consumption and cardiac performance. Circulat. Res.13, 522 (1963).CrossRefPubMedGoogle Scholar
  44. 44.
    Reneman, R. S., A. H. M. Jageneau, W. K. A. Schaper, F. A. S. Brouwer, W. van Gerven, Influence of counterpulsation on collateral circulation after acute occlusion of the left anterior descending coronary artery in dogs. Cardiovasc. Res.6, 45 (1972).CrossRefPubMedGoogle Scholar
  45. 45.
    Mulder, D. G., C. G. Frank, M. Nozaki, C. E. Miller, Cardiac assist pump. Hemodynamic observations in the experimental animal. Ann. Thoracic Surgery3, 337 (1967).CrossRefGoogle Scholar
  46. 46.
    Sugg, W. L., L. F. Martin, W. R. Webb, R. R. Ecker, Influence of counterpulsation on aortic right and left coronary blood flow following ligation of the left circumflex cornary artery. J. Thorac. Cardiovasc. Surgery59, 345 (1970).Google Scholar
  47. 47.
    Mullins, Ch. B., W. L. Sugg, B. M. Kennelly, D. C. Jones, J. H. Mitchell, Effect of arterial counterpulsation on left ventricular volume and pressure. Amer. J. Physiology220, 694, (1971).Google Scholar

Copyright information

© Dr. Dietrich Steinkopff Verlag 1974

Authors and Affiliations

  • W. Bleifeld
    • 1
  • G. Franken
    • 1
  • J. Meyer
    • 1
  • W. -D. Bussmann
    • 1
  1. 1.Department of Internal Medicine IRheinisch-Westfälische Technische Hochschule AachenAachen

Personalised recommendations