TY - JOUR
T1 - Comparison of the Hemodynamic Response to Intra-Aortic Balloon Counterpulsation in Patients With Cardiogenic Shock Resulting from Acute Myocardial Infarction Versus Acute Decompensated Heart Failure
AU - Malick, Waqas
AU - Fried, Justin Allan
AU - Masoumi, Amirali
AU - Nair, Abhinav
AU - Zuver, Amelia
AU - Huang, Athena
AU - Haythe, Jennifer
AU - Farr, Maryjane
AU - Rabbani, Le Roy
AU - Karmpaliotis, Dimitri
AU - Kirtane, Ajay Jayant
AU - Topkara, Veli Kemal
AU - Takeda, Koji
AU - Garan, Arthur Reshad
N1 - Funding Information:
Dr Garan is supported by the National Institutes of Health grant nos. KL2TR001874 and UL1TR001873 , has received honoraria from Abiomed, and is currently an unpaid advisor for Abiomed. Dr Kirtane reports institutional grant support from Abbott Vascular , Medtronic , Boston Scientific , Abiomed , CSI , Siemens , Philips , and ReCor Medical . None of the listed entities has had any involvement with the development of this manuscript. All other authors have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/12/15
Y1 - 2019/12/15
N2 - The intra-aortic balloon pump (IABP) neither benefits nor harms patients with acute myocardial infarction (AMI) with cardiogenic shock (CS) but may stabilize those with chronic heart failure who decompensate into CS. We sought to compare its hemodynamic effects in these 2 populations. We performed a retrospective analysis of the hemodynamic effects of IABP for AMI or acute decompensated heart failure (ADHF) patients with hemodynamic evidence of CS. The primary outcome was cardiac output (CO) change following insertion. In total, 205 patients were treated for CS resulting from AMI (73; 35.6%) or ADHF (132; 64.4%). At baseline, both cohorts had significant hemodynamic compromise with mean arterial pressure 75.6 ± 12.3 mm Hg, CO 3.02 ± 0.84 L/min, and cardiac power index 0.26 ± 0.06 W/m2; these parameters were nearly identical between groups though ADHF-CS patients had a higher pre-IABP mean pulmonary artery (PA) pressure than AMI-CS patients. After IABP insertion, ADHF-CS patients had moderate CO augmentation whereas AMI-CS experienced almost no improvement (0.58 ± 0.79 L/min vs 0.12 ± 1.00 L/min; p = 0.0009). Intracardiac filling pressures were reduced by similar amounts in both cohorts. Systemic vascular resistance was reduced in patients with ADHF-CS but not in those with AMI-CS. In conclusion, following IABP insertion, ADHF-CS patients experience roughly a 5-fold greater CO augmentation compared with AMI-CS patients. Pre-IABP PA pressure differences and differential systemic vascular resistance reduction may explain these results and shed light on recent evidence supporting IABP use in ADHF-CS and curbing it in AMI-CS.
AB - The intra-aortic balloon pump (IABP) neither benefits nor harms patients with acute myocardial infarction (AMI) with cardiogenic shock (CS) but may stabilize those with chronic heart failure who decompensate into CS. We sought to compare its hemodynamic effects in these 2 populations. We performed a retrospective analysis of the hemodynamic effects of IABP for AMI or acute decompensated heart failure (ADHF) patients with hemodynamic evidence of CS. The primary outcome was cardiac output (CO) change following insertion. In total, 205 patients were treated for CS resulting from AMI (73; 35.6%) or ADHF (132; 64.4%). At baseline, both cohorts had significant hemodynamic compromise with mean arterial pressure 75.6 ± 12.3 mm Hg, CO 3.02 ± 0.84 L/min, and cardiac power index 0.26 ± 0.06 W/m2; these parameters were nearly identical between groups though ADHF-CS patients had a higher pre-IABP mean pulmonary artery (PA) pressure than AMI-CS patients. After IABP insertion, ADHF-CS patients had moderate CO augmentation whereas AMI-CS experienced almost no improvement (0.58 ± 0.79 L/min vs 0.12 ± 1.00 L/min; p = 0.0009). Intracardiac filling pressures were reduced by similar amounts in both cohorts. Systemic vascular resistance was reduced in patients with ADHF-CS but not in those with AMI-CS. In conclusion, following IABP insertion, ADHF-CS patients experience roughly a 5-fold greater CO augmentation compared with AMI-CS patients. Pre-IABP PA pressure differences and differential systemic vascular resistance reduction may explain these results and shed light on recent evidence supporting IABP use in ADHF-CS and curbing it in AMI-CS.
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U2 - 10.1016/j.amjcard.2019.09.016
DO - 10.1016/j.amjcard.2019.09.016
M3 - Article
C2 - 31648782
AN - SCOPUS:85073832098
SN - 0002-9149
VL - 124
SP - 1947
EP - 1953
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 12
ER -