Imamura Teruhiko, Juricek Colleen, Nguyen Ann, Chung Ben, Rodgers Daniel, Sayer Gabriel, Sarswat Nitasha, Kim Gene, Raikhelkar Jayant, Ota Takeyoshi, Song Tae, Onsanger David, Burkhoff Daniel, Jeevanandam Valluvan, Uriel Nir
Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Avenue, Chicago, IL 60637 USA.
J Invasive Cardiol. 2018 Feb;30(2):56-61. Epub 2018 Jan 15.
The intraaortic balloon pump (IABP) is currently an essential tool to improve hemodynamics in patients with advanced heart failure (HF). This study investigated predictors for hemodynamic improvement or stabilization with IABP therapy in patients with advanced HF.
Patients with advanced HF and hemodynamic deterioration treated with IABP were enrolled in this retrospective study. Invasive hemodynamics were measured before IABP implantation and 2 weeks after IABP initiation. Significant degree of hemodynamic improvement was defined as 30% improvement in all three of the following variables: central venous pressure (CVP); pulmonary capillary wedge pressure (PCWP); and cardiac index (CI). Hemodynamic stabilization was counted in patients reaching CVP <12 mm Hg, PCWP <18 mm Hg, and CI >2.0 L/min/m² or CI >2.2 L/min/m² on inotropes.
Ninety-one patients (55 ± 12 years; 78% males) were evaluated. Seventeen patients (18.7%) achieved significant hemodynamic improvement, and baseline CVP >16 mm Hg was associated with this endpoint (P<.05). Thirty-two patients (35.2%) achieved hemodynamic stabilization; lower baseline heart rate (HR) and PCWP were associated with this stabilization (P<.05). Patients with HR <92 beats/min and PCWP <25 mm Hg achieved hemodynamic stabilization more frequently than those without HR <92 beats/min and PCWP <25 mm Hg (66.7% vs 19.7%; P<.05).
Elevated CVP and lower HR and PCWP before IABP initiation help predict high response to IABP.
主动脉内球囊反搏（IABP）目前是改善晚期心力衰竭（HF）患者血流动力学的重要工具。本研究调查了晚期HF患者接受IABP治疗后血流动力学改善或稳定的预测因素。
本回顾性研究纳入了接受IABP治疗且血流动力学恶化的晚期HF患者。在IABP植入前和IABP启动后2周测量有创血流动力学。血流动力学显著改善定义为以下三个变量均改善30%：中心静脉压（CVP）；肺毛细血管楔压（PCWP）；以及心脏指数（CI）。血流动力学稳定定义为达到以下标准的患者：CVP<12 mmHg，PCWP<18 mmHg，且CI>2.0 L/min/m²，或在使用血管活性药物时CI>2.2 L/min/m²。
共评估了91例患者（55±12岁；78%为男性）。17例患者（18.7%）实现了显著的血流动力学改善，基线CVP>16 mmHg与这一终点相关（P<0.05）。32例患者（35.2%）实现了血流动力学稳定；较低的基线心率（HR）和PCWP与这种稳定相关（P<0.05）。心率<92次/分钟且PCWP<25 mmHg的患者比心率≥92次/分钟且PCWP≥25 mmHg的患者更频繁地实现血流动力学稳定（66.7%对19.7%；P<0.05）。
IABP启动前CVP升高以及HR和PCWP降低有助于预测对IABP的高反应性。
