Acute Left Ventricular Unloading in Dogs With Chronic Heart Failure: Continuous Aortic Flow Augmentation Versus Intra-Aortic Balloon Pumping
Acute Left Ventricular Unloading in Dogs With Chronic Heart Failure: Continuous Aortic Flow Augmentation Versus Intra-Aortic Balloon Pumping
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DOI：
10.1016/j.cardfail.2009.01.003
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发表时间：
2009-08-01
影响因子：
6
通讯作者：
Brewer, Robert
中科院分区：
文献类型：
--
作者：
Sabbah, Hani N.;Wang, Mengjun;Brewer, Robert
背景：使用 Cancion 系统（Orqis Medical, Inc）进行的连续主动脉血流增强 (CAFA) 治疗被证明可以有效地减轻患有慢性心力衰竭 (HF) 的狗的左心室负荷。本研究比较了冠状动脉微栓塞诱发心力衰竭的血压正常犬中由 CAFA 引起的急性左心室 (LV) 减负荷程度与由主动脉内球囊反搏 (IABP) 引起的急性左心室减负荷程度。 方法和结果：对 7 只心力衰竭犬进行随机顺序的 CAFA 和 IABP 试验，间隔 1 周。在这两种情况下，积极治疗均维持 4 小时。 Cancion 系统采用双股骨入路配置进行定位，泵流量恒定为 250 mL/min。在使用两种装置的所有狗中，在基线以及开始 CAFA 或 IABP 后 2 小时和 4 小时测量左心室舒张末期压力 (EDP)、左心室收缩末期容积 (ESV) 和左心室射血分数 (EF)。治疗 4 小时结束时获得的血浆样本用于测量一系列循环生物标志物，包括神经激素、细胞因子以及 A 型和 B 型利尿钠肽。 IABP 对 LVEDP、LVESV 和 LVEF 无显着影响。相反，CAFA 显着降低 LVEDP 和 LVESV，并增加 LVEF。与 IABP 相比，CAFA 伴随着神经激素、细胞因子和利尿钠肽循环水平的显着改善。结论：结果表明，对于患有慢性心力衰竭且未并发持续心肌缺血或心源性休克的犬，CAFA 比 IABP 更能有效实现急性整体左心室减负荷。 (心脏衰竭杂志 2009;15;523-528)
Background: Continuous aortic flow augmentation (CAFA) therapy with the Cancion System (Orqis Medical, Inc) was shown to effectively unload the left ventricle in dogs with chronic heart failure (HF). This study compared the extent of acute left ventricular (LV) unloading elicited by CAFA to that elicited by intra-aortic balloon counterpulsation (IABP) in normotensive dogs with coronary microembolization-induced HF.Methods and Results: Seven HF dogs were studied with both CAFA and IABP in random order and 1 week apart. In both instances, active therapy was maintained for 4 hours. The Cancion system was positioned using a dual femoral approach configuration with a constant pump flow of 250 mL/min. In all dogs and with both devices, LV end-diastolic pressure (EDP), LV end-systolic volume (ESV), and LV ejection fraction (EF) were measured at baseline and at 2 and 4 hours after instituting CAFA or IABP. Plasma samples obtained at the end of 4 hours of therapy were used to measure a host of circulating biomarkers that included neurohormones, cytokines, and A-type and B-type natriuretic peptides. IABP had no significant effects on LVEDP, LVESV, and LVEF. In contrast, CAFA significantly decreased LVEDP and LVESV and increased LVEF. Compared with IABP, CAFA was accompanied by significant improvements in circulating levels of neurohormones, cytokines, and natriuretic peptides.Conclusions: The results indicate that CAFA is more effective than IABP in achieving acute global LV unloading in dogs with chronic HF not complicated by ongoing myocardial ischemia or cardiogenic shock. (J Cardiac Fail 2009;15;523-528)