Shiva K Annamalai1, Lyanne Buiten2, Michele L Esposito1, Vikram Paruchuri2, Andrew Mullin2, Catalina Breton2, Robert Pedicini2, Ryan O'Kelly1, Kevin Morine1, Benjamin Wessler2, Ayan R Patel2, Michael S Kiernan1, Richard H Karas1, Navin K Kapur3. 1. The Molecular Cardiology Research Institute, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts; The Acute Mechanical Circulatory Support Working Group, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts; The Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts. 2. The Molecular Cardiology Research Institute, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts; The Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts. 3. The Molecular Cardiology Research Institute, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts; The Acute Mechanical Circulatory Support Working Group, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts; The Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts. Electronic address: Nkapur@tuftsmedicalcenter.org.
Abstract
BACKGROUND: The utility of intra-aortic balloon counterpulsation pumps (IABPs) in low cardiac output states is unknown and no studies have explored the impact of IABP therapy on ventricular workload in patients with advanced heart failure (HF). For these reasons, we explored the acute hemodynamic effects of IABP therapy in patients with advanced HF. METHODS: We prospectively studied 10 consecutive patients with stage D HF referred for IABP placement before left ventricular assist device (LVAD) surgery and compared with 5 control patients with preserved left ventricular (LV) ejection fraction (EF) who did not receive IABP therapy. Hemodynamics were recorded using LV conductance and pulmonary artery catheters. Cardiac index (CI)-responder and CI-nonresponder status was assigned a priori as being "equal to or above" or below the median of the IABP effect on CI, respectively, within 24 hours after IABP activation. RESULTS: Compared with controls, patients with advanced HF had lower LVEF, lower LV end-systolic pressure, lower LV stroke work, and higher LV end-diastolic pressures and volumes before IABP activation. IABP activation reduced LV stroke work primarily by reducing end-systolic pressure. IABP therapy increased CI by a median of 20% as well as increased diastolic pressure time index and the myocardial oxygen supply:demand ratio. Compared with CI-nonresponders, CI-responders had higher systemic vascular resistance, lower right heart filling pressures, and a trend toward lower left heart filling pressures with improved indices of right heart function. Compared with CI-nonresponders, the diastolic pressure time index was increased among CI-responders. CONCLUSIONS: IABP therapy may be effective at reducing LV stroke work, increasing CI, and favorably altering the myocardial oxygen supply:demand ratio in patients with advanced HF, especially among patients with low right heart filling pressures and high systemic vascular resistance.
BACKGROUND: The utility of intra-aortic balloon counterpulsation pumps (IABPs) in low cardiac output states is unknown and no studies have explored the impact of IABP therapy on ventricular workload in patients with advanced heart failure (HF). For these reasons, we explored the acute hemodynamic effects of IABP therapy in patients with advanced HF. METHODS: We prospectively studied 10 consecutive patients with stage D HF referred for IABP placement before left ventricular assist device (LVAD) surgery and compared with 5 control patients with preserved left ventricular (LV) ejection fraction (EF) who did not receive IABP therapy. Hemodynamics were recorded using LV conductance and pulmonary artery catheters. Cardiac index (CI)-responder and CI-nonresponder status was assigned a priori as being "equal to or above" or below the median of the IABP effect on CI, respectively, within 24 hours after IABP activation. RESULTS: Compared with controls, patients with advanced HF had lower LVEF, lower LV end-systolic pressure, lower LV stroke work, and higher LV end-diastolic pressures and volumes before IABP activation. IABP activation reduced LV stroke work primarily by reducing end-systolic pressure. IABP therapy increased CI by a median of 20% as well as increased diastolic pressure time index and the myocardial oxygen supply:demand ratio. Compared with CI-nonresponders, CI-responders had higher systemic vascular resistance, lower right heart filling pressures, and a trend toward lower left heart filling pressures with improved indices of right heart function. Compared with CI-nonresponders, the diastolic pressure time index was increased among CI-responders. CONCLUSIONS:IABP therapy may be effective at reducing LV stroke work, increasing CI, and favorably altering the myocardial oxygen supply:demand ratio in patients with advanced HF, especially among patients with low right heart filling pressures and high systemic vascular resistance.
Authors: Shiva K Annamalai; Michele L Esposito; Lara A Reyelt; Peter Natov; Lena E Jorde; Richard H Karas; Navin K Kapur Journal: Circ Heart Fail Date: 2018-08 Impact factor: 8.790
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