Improved Hemodynamic Response Following Intra-Aortic Balloon Pump Support in Patients with Heart Failure Related Cardiogenic Shock and Severe Right Ventricle Dysfunction

Abstract

<h3>Purpose</h3> Intra-aortic balloon pump (IABP) support is a commonly used strategy in patients with heart failure related cardiogenic shock (HF-CS), however its efficacy in those with out-of-proportion right ventricular (RV) failure is unknown. We aim to assess the hemodynamic response of IABP support for HF-CS over a spectrum of RV function as defined by pulmonary artery pulsatility index (PAPi). <h3>Methods</h3> This is a single center, retrospective study assessing IABP support in consecutive HF-CS patients. We analyzed patients who underwent IABP support with or without baseline inotropic support and excluded patients with acute coronary syndromes or mechanical support devices. We stratified the cohort by PAPi ([pulmonary artery systolic pressure - pulmonary artery diastolic pressure] / central venous pressure) below or above 2. Hemodynamics were compared pre and 48 hours post IABP insertion. <h3>Results</h3> 46 patients were included with median age 61 yrs and left ventricular ejection fraction 19%, 32.6% women, and 91% on inotropes. 22 patients had PAPi > 2 and 24 had < 2. No significant differences in baseline characteristics were observed except for greater age in patients with PAPi > 2 (61 vs 51 yr). Within 48 hours of IABP insertion, patients with PAPi < 2 had significant improvement in central venous pressure, mean pulmonary artery pressure, and cardiac index (P < 0.05 for all, Figure). Although baseline hemodynamics were better optimized in patients with PAPi > 2, only CI improved significantly post IABP (Figure). No significant change in diuretic or inotrope dosing was observed in patients post-IABP irrespective of PAPi (P > 0.05). No significant change in 30-day survival was observed between patients with PAPi < 2 (n=3, 12.5%) versus PAPi > 2 (n=1, 4.5%; P=0.34). <h3>Conclusion</h3> In patients with HF-CS with baseline PAPi <2, we observed a positive hemodynamic response which may infer treatment benefit in patients with out-of-proportion RV dysfunction.