Hemodynamic Response after Intra-Aortic Balloon Counter-Pulsation in Cardiac Amyloidosis and Cardiogenic Shock

BackgroundIn those with heart failure-related cardiogenic shock, intra-aortic balloon pump may improve hemodynamics and be useful as a bridge to advanced therapies. We explore whether those with cardiac amyloidosis and heart failure-related cardiogenic shock might experience hemodynamic improvement and describe the hemodynamic response after intra-aortic balloon pump.MethodsWe retrospectively identified consecutive patients with a diagnosis of cardiac amyloid, either light-chain or transthyretin, who were admitted to our intensive care unit with heart failure-related cardiogenic shock. Patients were excluded if intra-aortic balloon pump was placed during heart transplant or for shock related to acute myocardial infarction. Invasive hemodynamics before and after intra-aortic balloon pump placement were assessed.ResultsWe identified 23 patients with cardiac amyloid who had an intra-aortic balloon pump placed for heart failure-related cardiogenic shock. One-year survival was 74% and most (65%) were bridged to heart transplant while one was bridged to destination left ventricular assist device. Following intra-aortic balloon pump, mean arterial pressure, cardiac index, and cardiac power index were significantly increased, while mean right atrial pressure, mean pulmonary artery pressure, and pulmonary capillary wedge pressure were all significantly reduced. Smaller left ventricular end diastolic diameter (per cm) was associated with higher likelihood of a cardiac index of < 2.2 L/min/m2following intra-aortic balloon pump (OR 0.16, CI 0.01 – 0.93, P=0.04).ConclusionIntra-aortic balloon pump significantly improved cardiac index while reducing right atrial pressure, mean pulmonary artery pressure, and pulmonary capillary wedge pressure in CA patients with heart failure-related cardiogenic shock.