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Effect of external counterpulsation on cardiac work following cardiac surgery: implications of the mechanism responsible for clinical benefits.

AbstractBACKGROUND:
External counterpulsation (ECP) has been recognized as a non-invasive treatment for chronic refractory angina or heart failure. However, the mechanisms responsible for the clinical benefits of ECP therapy remain elusive. Moreover, the clinical significance of ECP therapy for postoperative patients has not been established yet.
METHODS:
Six adult patients received ECP therapy for 60 min under pulmonary artery catheter monitoring after cardiac surgery. Hemodynamic data were obtained before ECP therapy (pre-ECP), 20 min after ECP was commenced (20-min-ECP), 40 min after ECP was commenced (40-min-ECP), and after ECP therapy (post-ECP).
RESULTS:
The mean right atrial pressure (pre-ECP: 9 ± 4 mmHg; 20-min-ECP: 12 ± 5 mmHg; 40-min-ECP: 12 ± 4 mmHg; and post-ECP: 9 ± 4 mmHg), pulmonary wedge pressure (16 ± 6 mmHg, 20 ± 7 mmHg, 20 ± 7 mmHg, and 17 ± 7 mmHg, respectively), cardiac index (2.4 ± 0.4 l/min/m(2), 2.8 ± 0.6 l/min/m(2), 2.7 ± 0.5 l/min/m(2), and 2.5 ± 0.4 l/min/m(2), respectively), cardiac work index (2.5 ± 0.4 kgm/m(2), 3.3 ± 0.8 kgm/m(2), 3.1 ± 0.8 kgm/m(2), and 2.6 ± 0.5 kgm/m(2), respectively), and left ventricular stroke work index (32 ± 7 gm/m(2), 41 ± 12 gm/m(2), 39 ± 12 gm/m(2), and 33 ± 8 gm/m(2), respectively) significantly (p<0.05) increased after ECP was commenced (pre-ECP vs. 20-min-ECP) and decreased after ECP was discontinued (40-min-ECP vs. post-ECP). Significant (p<0.001) diastolic augmentation (20-min-ECP: 24 ± 6%, 40-min-ECP: 23 ± 5%) and systolic unloading (3 ± 1%, and 3 ± 1%, respectively) were obtained. No clinical adverse effects were observed.
CONCLUSIONS:
ECP increases venous return, cardiac output, and cardiac work in addition to diastolic augmentation and systolic unloading. These actions may play important roles in the clinical benefits of ECP therapy. Our data also suggest that ECP is beneficial for patients undergoing cardiac surgery.
AuthorsTsuyoshi Shimizu, Shunei Kyo, Sei Morizumi, Takashi Ando, Shigeyoshi Gon, Yoshihiro Suematsu
JournalJournal of cardiology (J Cardiol) Vol. 59 Issue 1 Pg. 84-90 (Jan 2012) ISSN: 1876-4738 [Electronic] Netherlands
PMID22018874 (Publication Type: Journal Article)
CopyrightCopyright © 2011 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
Topics
  • Aged
  • Blood Pressure
  • Cardiac Output
  • Cardiac Surgical Procedures
  • Counterpulsation
  • Female
  • Humans
  • Male
  • Postoperative Care
  • Pulmonary Wedge Pressure
  • Time Factors
  • Ventricular Function, Left

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