Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Kauffman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, Cleveland, Ohio.
Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, and the Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
J Card Fail. 2024 Oct;30(10):1255-1264. doi: 10.1016/j.cardfail.2024.07.019.
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.
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 after IABP (odds ratio 0.16, 95% confidence interval 0.01-0.93, P = .04).
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.
在心力衰竭相关性心原性休克（HF-CS）患者中，主动脉内球囊泵（IABP）可能改善血液动力学，作为先进治疗的桥梁很有用。我们探讨心脏淀粉样变和 HF-CS 患者是否可能经历血液动力学改善，并描述 IABP 后的血液动力学反应。
我们回顾性地确定了连续诊断为心脏淀粉样变（轻链或转甲状腺素）的患者，这些患者因 HF-CS 被收入我们的重症监护病房。如果 IABP 是在心脏移植期间或因急性心肌梗死相关休克放置的，则排除患者。评估 IABP 放置前后的有创血液动力学。我们确定了 23 例因 HF-CS 放置 IABP 的心脏淀粉样变患者。1 年生存率为 74%，大多数（65%）患者桥接至心脏移植，尽管有 1 例患者桥接至目的地左心室辅助装置。IABP 后，平均动脉压、心指数和心功率指数显著增加，而平均右心房压、平均肺动脉压和肺毛细血管楔压均显著降低。左心室舒张末期直径（每厘米）较小与 IABP 后心指数<2.2 L/min/m 的可能性更高相关（比值比 0.16，95%置信区间 0.01-0.93，P=0.04）。
IABP 显著改善了心力衰竭相关性心原性休克心脏淀粉样变患者的心指数，同时降低了右心房压、平均肺动脉压和肺毛细血管楔压。
