Hemodynamic Response after Intra-aortic Balloon Counter-Pulsation in Cardiac Amyloidosis and Cardiogenic Shock.

Autor: Longinow J; Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Kauffman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, Cleveland, Ohio., Martens P; Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, and the Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium., Il'giovine ZJ; Centennial Heart, Tristar Centennial Medical Center, Nashville, Tennessee., Higgins A; Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Kauffman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, Cleveland, Ohio., Ives L; Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Kauffman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, Cleveland, Ohio., Soltesz EG; Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio., Tong MZ; Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio., Estep JD; Department of Cardiovascular Medicine, Cleveland Clinic Weston Hospital, Weston, Florida., Starling RC; Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Kauffman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, Cleveland, Ohio., Tang WHW; Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Kauffman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, Cleveland, Ohio., Hanna M; Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Kauffman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, Cleveland, Ohio., Lee R; Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Kauffman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, Cleveland, Ohio. Electronic address: Leer2@ccf.org.
Jazyk: angličtina
Zdroj: Journal of cardiac failure [J Card Fail] 2024 Oct; Vol. 30 (10), pp. 1255-1264.
DOI: 10.1016/j.cardfail.2024.07.019
Abstrakt: Background: In those with heart failure-related cardiogenic shock (HF-CS), an intra-aortic balloon pump (IABP) may improve hemodynamics and be useful as a bridge to advanced therapies. We explore whether those with cardiac amyloidosis and HF-CS might experience hemodynamic improvement and describe the hemodynamic response after IABP.
Methods and Results: We retrospectively identified consecutive patients with a diagnosis of cardiac amyloid, either light chain or transthyretin, who were admitted to our intensive care unit with HF-CS. Patients were excluded if an IABP was placed during heart transplant or for shock related to acute myocardial infarction. Invasive hemodynamics before and after IABP placement were assessed. We identified 23 patients with cardiac amyloid who had an IABP placed for HF-CS. The 1-year survival rate was 74% and most (65%) were bridged to heart transplant, although 1 patient was bridged to destination left ventricular assist device. After IABP, the mean arterial pressure, cardiac index, and cardiac power index were significantly increased, whereas mean right atrial pressure, mean pulmonary artery pressure, and pulmonary capillary wedge pressure were all significantly decreased. A smaller left ventricular end-diastolic diameter (per cm) was associated with a higher likelihood of a cardiac index of <2.2 L/min/m 2 after IABP (odds ratio 0.16, 95% confidence interval 0.01-0.93, P = .04).
Conclusions: IABP significantly improved cardiac index while decreasing right atrial pressure, mean pulmonary artery pressure, and pulmonary capillary wedge pressure in cardiac amyloidosis patients with HF-CS.
Competing Interests: Funding and Disclosures Dr Longinow is supported by a grant from Pfizer. Dr Pieter Martens is supported by a grant from the Belgian American Educational Foundation (BAEF) and by the Frans Van de Werf Fund. Dr Andrew Higgins has received honoraria from Abbott. Dr Edward Soltesz has received honoraria from Abiomed, Abbott, and Atricure. Dr Wilson Tang served as consultant for Sequana Medical, Cardiol Therapeutics, Genomics plc, Zehna Therapeutics, Renovacor, WhiteSwell, Kiniksa, Boston Scientific, and CardiaTec Biosciences, and has received honorarium from Springer Nature and American Board of Internal Medicine. Dr Mazen Hanna is a consultant for Alnylam Pharmaceuticals Inc., Eidos, Akcea Therapeutics, and Pfizer Inc. Dr Lee has received honorarium from Getinge, unrelated to the subject and content of this paper. Dr Estep has served as a consultant and has received honorarium from Abbott, Bioventrix, and Getinge, all unrelated to the subject and contents of this paper. All other authors have no relationships to disclose.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: