Haemodynamic effects of intra-aortic balloon pumps stratified by baseline pulmonary artery pulsatility index

Authors

George Kalapurakal, Advocate Health - MidwestFollow
Vinh Q. Chau, Advocate Health - MidwestFollow
Teruhiko Imamura, Second Department of Internal Medicine, University of Toyama, Toyama, Japan.
Sanika Tolia, Advocate Health - MidwestFollow
Chris Sciamanna, Advocate Health - MidwestFollow
Gregory P. Macaluso, Advocate Health - MidwestFollow
Anjali Joshi, Advocate Health - MidwestFollow
Jessica Pillarella, Advocate Health - MidwestFollow
Sunil Pauwaa, Advocate Health - MidwestFollow
Muhyaldeen Dia, Advocate Health - MidwestFollow
Tarek Kabbany, Advocate Health - Midwest
James Monaco, Advocate Health - MidwestFollow
Mark Dela Cruz, Advocate Health - MidwestFollow
William G. Cotts, Advocate Health - MidwestFollow
Patroklos Pappas, Advocate Health - MidwestFollow
Antone J. Tatooles, Advocate Health - MidwestFollow
Nikhil Narang, Advocate Health - MidwestFollow

Recommended Citation

Kalapurakal G, Chau VQ, Imamura T, et al. Haemodynamic effects of intra-aortic balloon pumps stratified by baseline pulmonary artery pulsatility index. ESC Heart Fail. Published online September 18, 2024. doi:10.1002/ehf2.15083

Affiliations

Advocate Christ Medical Center

Abstract

Aims:Intra-aortic balloon pump (IABP) devices are commonly used in patients with heart failure related cardiogenic shock (HF-CS), including those with out-of-proportion right ventricular (RV) dysfunction. Pulmonary artery pulsatility index (PAPi) is a haemodynamic surrogate for RV performance. We aimed to assess short-term haemodynamic changes in patients with HF-CS following IABP support stratified by baseline PAPi.

Methods and results:This is a single-centre study of 67 consecutive patients with HF-CS who underwent IABP placement between 2020 and 2022. The primary aim was haemodynamic changes of specific variables on pulmonary artery catheter monitoring over 72 h following IABP placement. Secondary aims were clinically significant changes in diuretic regimens, changes in inotropes or vasopressors at 72 h following IABP, along with clinical outcomes. Prior to IABP placement, 57% of the total cohort (median age 59 years [48, 69], 31% female) had Society of Cardiovascular Angiography and Interventions Stage C HF-CS. Thirty-eight (56%) patients had a PAPi <2.0. Following 72 h of IABP support, the PAPi <2.0 group had an observed significant decrease in central venous pressure (CVP; 20 to 12 mmHg, P < 0.001) and mean pulmonary artery pressure (mPAP; 37.5 to 28.5 mmHg, P = 0.001), and an increase in PAPi (1 to 1.6, P = 0.001). No significant change in cardiac index (CI; 2 to 2.1 L/min/m2, P = 0.31) was observed. The PAPi ≥2.0 group (N = 29) had no observed significant change in CVP (10 to 8 mmHg, P = 0.47), or PAPi (2.6 to 2.8, P = 0.92), but there was a significant improvement in CI (1.9 to 2.5 L/min/m2, P = 0.004) along with reduction in mPA (37 to 29 mmHg, P = 0.03). The PAPi <2.0 group had a significant increase in diuretic requirement (52.6% vs. 20.7%, P = 0.01) and numerically greater addition of inotropes/vasopressors (47.3% vs. 34.4%, P = 0.07) compared with the PAPi ≥2.0 group at 72 h following IABP placement. Significantly more patients in the PAPi ≥2.0 group underwent left ventricular assist device (55.2% vs. 26.3%, P = 0.02), with no overall significant differences observed in escalation to veno-arterial extracorporeal membrane oxygenation, 30-day mortality, renal replacement therapy post-IABP, or rates of heart transplantation.

Conclusions:IABP devices in those with HF-CS and low or abnormal PAPi may provide modest short-term haemodynamic benefits without significant improvement in CI, along with greater need for adjustment in medical therapeutics to achieve haemodynamic optimization.

Type

Article

PubMed ID

39294848