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. 2018 Nov;37(11):1313-1321.
doi: 10.1016/j.healun.2018.03.011. Epub 2018 Mar 20.

Clinical and hemodynamic effects of intra-aortic balloon pump therapy in chronic heart failure patients with cardiogenic shock

Justin A Fried  1 , Abhinav Nair  1 , Koji Takeda  2 , Kevin Clerkin  1 , Veli K Topkara  2 , Amirali Masoumi  1 , Melana Yuzefpolskaya  1 , Hiroo Takayama  2 , Yoshifumi Naka  2 , Daniel Burkhoff  1 , Ajay Kirtane  1 , Dimitrios Karmpaliotis  1 , Jeffrey Moses  1 , Paolo C Colombo  1 , A Reshad Garan  3
Affiliations

Clinical and hemodynamic effects of intra-aortic balloon pump therapy in chronic heart failure patients with cardiogenic shock

Justin A Fried et al. J Heart Lung Transplant. 2018 Nov.

Abstract

Background: The role of the intra-aortic balloon pump (IABP) in acute decompensated heart failure (HF) with cardiogenic shock (CS) is largely undefined. In this study we sought to assess the hemodynamic and clinical response to IABP in chronic HF patients with CS and identify predictors of response to this device.

Methods: We retrospectively reviewed all patients undergoing IABP implantation from 2011 to 2016 at our institution to identify chronic HF patients with acute decompensation and CS (cardiac index <2.2 liters/min/m2 and systolic blood pressure <90 mm Hg or need for vasoactive medications to maintain this level). Clinical deterioration on IABP was defined as failure to bridge to either discharge on medical therapy or durable heart replacement therapy (HRT; durable left ventricular assist device or heart transplant) with IABP alone.

Results: We identified 132 chronic HF patients with IABP placed after decompensation with hemodynamic evidence of CS. Overall 30-day survival was 84.1%, and 78.0% of patients were successfully bridged to HRT or discharge without need for escalation of device support. The complication rate during IABP support was 2.3%. Multivariable analysis identified ischemic cardiomyopathy (odds ratio [OR] 3.24, 95% confidence interval [CI] 1.16 to 9.06; p = 0.03) and pulmonary artery pulsatility index (PAPi) <2.0 (OR 5.04, 95% CI 1.86 to 13.63; p = 0.001) as predictors of clinical deterioration on IABP.

Conclusions: Overall outcomes with IABP in acute decompensated chronic HF patients are encouraging, and IABP is a reasonable first-line device for chronic HF patients with CS. Baseline right ventricular function, as measured by PAPi, is a major predictor of outcomes with IABP in this population.

Keywords: IABP; cardiogenic shock; counter-pulsation; heart failure; hemodynamics; super responder.

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Figures

Figure 1
Figure 1
Patient selection flowchart. CI, cardiac index; HD, hemodynamic; HF, heart failure; IABP, intra-aortic balloon pump; LHC, left-heart catheterization; NICM, non-ischemic cardiomyopathy; NSTEMI, non-ST elevation myocardial infarction; OHT, orthotopic heart transplant; OSH, outside hospital; PCI, percutaneous coronary intervention; STEMI, ST-elevation myocardial infarction; VT, ventricular tachycardia
Figure 2
Figure 2
Study cohort clinical outcomes. HD, hemodynamic; HF, heart failure; HRT, heart replacement therapy; IABP, intra-aortic balloon pump; LVAD, left-ventricular assist device; MCS, mechanical circulatory support; OHT, orthotopic heart transplant
Figure 3
Figure 3
Predictors of clinical response. Association between identified risk factors and inadequate clinical response leading to death or device escalation. RF, risk factor.
Figure 4
Figure 4
Change in Cardiac Output Following IABP Insertion. The top quartile of patients was pre-specified as “super-responders”. IABP, intra-aortic balloon pump; L, liters; min, minute.
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References

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