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European Heart Journal Advance Access originally published online on February 16, 2005
European Heart Journal 2005 26(12):1235-1241; doi:10.1093/eurheartj/ehi137
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

The effect of intra-aortic balloon counterpulsation on left ventricular functional recovery early after acute myocardial infarction: a randomized experimental magnetic resonance imaging study

Clerio F. Azevedo1, Luciano C. Amado1, Dara L. Kraitchman2, Bernhard L. Gerber1, Thor Edvardsen1, Nael F. Osman2, Carlos E. Rochitte1, Katherine C. Wu1 and Joao A.C. Lima1,*

1Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD 21287-0409, USA
2Department of Radiology, Johns Hopkins Hospital, Baltimore, MD, USA

Received 28 July 2004; revised 30 November 2004; accepted 5 January 2005; online publish-ahead-of-print 16 February 2005.

* Corresponding author: Tel: +1 410 614 1284; fax: +1 410 614 8222. E-mail address: jlima{at}jhmi.edu

Aims We sought to determine whether intra-aortic balloon pump (IABP) counterpulsation improves the recovery of left ventricular (LV) systolic function after reperfused acute myocardial infarction (AMI).

Methods and results Fourteen dogs underwent 90-min coronary artery occlusion followed by reperfusion. Seven animals were randomized to IABP counterpulsation immediately after reperfusion. Tagged, cine, and contrast-enhanced magnetic resonance imaging were used for regional and global LV functional assessment and MI characterization, respectively. Image acquisition was performed at 1 h, 6 h, and 24 h after reperfusion, during which the IABP device was paused.

Animals randomized to IABP demonstrated an earlier improvement of LV ejection fraction when compared with controls (25±3 vs. 25±2% at 1 h, P=0.91; 36±3 vs. 26±2% at 6 h, P=0.015; and 38±3 vs. 35±1% at 24 h, P=0.34). Regional functional analyses revealed the same behaviour among non-infarcted risk regions, i.e., earlier circumferential systolic strain improvement in the IABP group than in controls (–5.4±0.4 vs. –5.3±0.5% at 1 h, P=0.86; –12.1±1.0 vs. –6.0±0.4% at 6 h, P<0.001; and –13.9±1.1% vs. –12.8±0.6% at 24 h, P=0.40). Importantly, however, the degree of LV functional recovery 24 h after reperfusion was similar whether IABP counterpulsation was used or not.

Conclusion IABP counterpulsation accelerates but does not significantly improve the recovery of LV systolic function after reperfused AMI.

Key Words: Intra-aortic balloon pump • Magnetic resonance imaging • Myocardial infarction • Myocardial stunning


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