Intra-aortic Balloon Pump for Acute-on-Chronic Heart Failure Complicated by Cardiogenic Shock

Morici, Nuccia; Marini, Claudia; Sacco, Alice; Tavazzi, Guido; Saia, Francesco; Palazzini, Matteo; Oliva, Fabrizio; Ferrari, Gaetano Maria De; Colombo, P.C.; Kapur, Navin K.; Garan, A.R.; Pappalardo, Federico

doi:10.1016/j.cardfail.2021.11.009

Cited by 19 publications

(9 citation statements)

References 78 publications

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“…The chronically elevated systemic vascular resistances of heart failure patients may benefit from treatments aiming to reduce the afterload and improving the ventriculo‐arterial coupling. IABP has demonstrated to promote such mechanisms and enhance haemodynamics in the ADHF‐CS cohort unlike in the AMI‐CS one 24,25 . Similarly, more than half of ADHF‐CS group in our cohort received sodium nitroprusside.…”

Section: Discussionmentioning

confidence: 68%

“…IABP has demonstrated to promote such mechanisms and enhance haemodynamics in the ADHF-CS cohort unlike in the AMI-CS one. 24,25 Similarly, more than half of ADHF-CS group in our cohort received sodium nitroprusside. The high prevalence of dilated left ventricle and severe functional mitral regurgitation at index echocardiography as well as the afore-mentioned congestive haemodynamic profile at presentation create a window of opportunity for vasodilator therapy even in this unstable setting.…”

Section: Discussionmentioning

confidence: 87%

“…most commonly used adrenergic drug in AMI-CS patients was norepinephrine (79.3%), while epinephrine was the most commonly used in the ADHF-CS group (65.5%). Maximum inotropic score was higher in AMI-CS population[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] vs. 11 (IQR…”

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confidence: 99%

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Differences between cardiogenic shock related to acute decompensated heart failure and acute myocardial infarction

Bertaina,

Morici,

Frea

et al. 2023

ESC Heart Failure

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AimsThe present analysis from the multicentre prospective Altshock‐2 registry aims to better define clinical features, in‐hospital course, and management of cardiogenic shock complicating acutely decompensated heart failure (ADHF‐CS) as compared with that complicating acute myocardial infarction (AMI‐CS).Methods and resultsAll patients with AMI‐CS or ADHF‐CS enrolled in the Altshock‐2 registry between March 2020 and February 2022 were selected. The primary objective was the characterization of ADHF‐CS patients as compared with AMI‐CS. In‐hospital length of stay and mortality were secondary endpoints. One‐hundred‐ninety of the 238 CS patients enrolled in the aforementioned period were considered for the present analysis: 101 AMI‐CS (80% ST‐elevated myocardial infarction and 20% non‐ST‐elevated myocardial infarction) and 89 ADHF‐CS. As compared with AMI‐CS, ADHF‐CS patients were younger [63 (IQR 59–76) vs. 67 (IQR 54–73) years, P = 0.01], but presented with higher creatinine [1.6 (IQR 1.0–2.6) vs. 1.2 (IQR 1.0–1.4) mg/dL, P < 0.001], bilirubin [1.3 (IQR 0.9–2.3) vs. 0.6 (IQR 0.4–1.1) mg/dL, P = 0.01], and central venous pressure values [14 mmHg (IQR 8–12) vs. 10 mmHg (IQR 7–14),P = 0.01]. Norepinephrine was the most common catecholamine used in AMI‐CS (79.3%), whereas epinephrine was used more commonly in ADHF‐CS (65.5%); 75.8% vs. 46.6% received a temporary mechanical support in AMI‐CS and ADHF‐CS, respectively (P < 0.001). Length of hospital stay was longer in the latter [28 (IQR 13–48) vs. 17 (IQR 9–29) days, P = 0.001]. Heart replacement therapies were more frequently used in the ADHF‐CS group (heart transplantation 13.5% vs. 0% and left ventricular assist device 11% vs. 2%, P < 0.01 and 0.01, respectively). In‐hospital mortality was 41.1% (38.6% AMI‐CS vs. 43.8% ADHF‐CS, P = 0.5).ConclusionsADHF‐CS is characterized by a higher prevalence of end‐organ and biventricular dysfunction at presentation, a longer hospital length of stay, and higher need of heart replacement therapies when compared with AMI‐CS. In‐hospital mortality was similar between the two aetiologies. Our data warrant development of new management protocols focused on CS aetiology.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 87%

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Differences between cardiogenic shock related to acute decompensated heart failure and acute myocardial infarction

Bertaina,

Morici,

Frea

et al. 2023

ESC Heart Failure

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“…However, several observational studies have indicated that the IABPs can improve outcome in cardiogenic shock due to acute decompensated heart failure (HF-CS). Compared to AMI-CS, it has a different underlying pathophysiology and, accordingly, different responses to pharmacological treatments and mechanical support (23,24). IABP combines a more substantial effect on left ventricular afterload with a modest increase (0.5-1.0 L/min; 25, 26) in cardiac output and would therefore be most suitable in clinical scenarios characterized by a disproportionate increase in afterload without profound hemodynamic compromise.…”

Section: Discussionmentioning

confidence: 99%

Single center experience and early outcomes of Impella 5.5

Funamoto

Kunavarapu²,

Kwan³

et al. 2023

Front. Cardiovasc. Med.

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BackgroundAcute decompensated heart failure (HF) and cardiogenic shock (CS) frequently are refractory to conservative treatment and require mechanical circulatory support (MCS). We report our early clinical experience and evaluate patient outcomes with the newer generation surgical Impella 5.5.MethodsSeventy patients that underwent Impella 5.5 implantation between October 2019 and December 2021 at a single center were enrolled in this study. Pre-operative characteristics, peri-operative clinical course information, and post-operative outcomes were retrospectively collected.ResultsFifty-seven (81%) patients survived to discharge, and 51 (76%) patients survived at the time of the first 30 days post-discharge visit. Thirty-one patients (44%) received Impella support for a bridge to advanced surgical heart failure therapy (transplant or durable left ventricular assist device [LVAD]), 27 (39%) cases were used for a bridge to recovery/decision and 12 (17.1%) cases was used for planned perioperative support for high-risk cardiac surgery procedure.ConclusionOur results suggest that Impella 5.5 provides favorable survival in the management of HF and CS, particularly used for a bridge to heart transplant or LVAD. Early extubation and mobilization with high flow circulatory support allowed effective tailoring of MCS approaches from peri-operative support for high-risk cardiac surgery, bridge to recovery, and to advanced surgical heart failure therapy.

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“…Although for patients with acute myocardial infarction and CS, IABP has no effect on all-cause mortality, 14 in the context of acute-on-chronic heart failure complicated by cardiogenic shock IABP can provide potential benefit to those patient candidates for cardiac replacement therapies. 15 …”

Section: Introductionmentioning

confidence: 99%

Impact of intra-aortic balloon counterpulsation on all-cause mortality among patients with Takotsubo syndrome complicated by cardiogenic shock: results from the German-Italian-Spanish (GEIST) registry

Santoro

Gil

Stiermaier

et al. 2023

European Heart Journal Open

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Aims Takotsubo syndrome (TTS) is an acute and reversible left ventricular dysfunction and can be complicated by cardiogenic shock (CS). However, few data are available on optimal care in TTS complicated by CS. Aim of this study was to evaluate short- and long-term impact of Intra-aortic balloon pumping (IABP) on mortality in this setting. Methods and results In a multicenter, international registry on TTS 2248 consecutive patients were enrolled from 38 centers from Germany, Italy, and Spain. Of the 2248 patients, 212 (9.4%) experienced CS. Patients with CS had a higher prevalence of diabetes (27% vs 19%), male sex (25% vs 10%) and right ventricular involvement (10% vs 5%) (p < 0.01 in all cases). Forty-three patients with CS (20% out of 212) received IABP within 8 h (IQR 4-18) after admission. No differences in terms of age, gender, cardiovascular risk factors and admission LVEF were found among patients with and without IABP. There were no significant differences in terms of 30-day mortality (16% vs 17%, p = 0.98), length of hospitalization (18.9vs16.7 days, p = 0.51) and need of invasive ventilation (35% vs 41%, p = 0.60) among two groups: 30-day survival was not significantly different even after propensity score adjustment (Log-Rank p = 0.73). At 42-month follow-up, overall mortality in patients with CS and TTS was 35%, not significantly different between patients receiving IABP and not (37% vs 35%, p = 0.72). Conclusions In a large multicenter observational registry, the use of IABP was not associated with lower mortality rates at short- and long-term follow-up in patients with TTS and CS.

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Intra-aortic Balloon Pump for Acute-on-Chronic Heart Failure Complicated by Cardiogenic Shock

Cited by 19 publications

References 78 publications

Differences between cardiogenic shock related to acute decompensated heart failure and acute myocardial infarction

Differences between cardiogenic shock related to acute decompensated heart failure and acute myocardial infarction

Single center experience and early outcomes of Impella 5.5

Impact of intra-aortic balloon counterpulsation on all-cause mortality among patients with Takotsubo syndrome complicated by cardiogenic shock: results from the German-Italian-Spanish (GEIST) registry

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