Predictors of Hemodynamic Improvement and Stabilization Following Intraaortic Balloon Pump Implantation in Patients With Advanced Heart Failure

T Imamura, C Juricek, A Nguyen, B Chung, D Rodgers, G Sayer, N Sarswat, G Kim, J Raikhelkar, T Ota, T Song, D Onsanger, D Burkhoff, V Jeevanandam and N Uriel
J Invasive Cardiol 2018;30:56-61

OBJECTIVES: 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. METHODS: 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/m(2) or CI >2.2 L/min/m(2) on inotropes. RESULTS: 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). CONCLUSION: Elevated CVP and lower HR and PCWP before IABP initiation help predict high response to IABP.

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