Predictors of IABP Failure

Question 1

ADHF

Answer 1

Acute Decompensating Heart Failure

Question 2

How is ADHF usually treated?

Answer 2

Dieresis, inotropes and sometimes IABP, Impella or ECMO

Question 3

What did this study look at?

Answer 3

Hemodynamic effects of treating cardiogenic shock complicating non-AMI ADHF.

Question 4

Who did the study look at?

Answer 4

Known or newly diagnosed cardiomyopathy who required IABP for treatment of CS.

Question 5

How did they define cardiogenic shock

Answer 5

Systolic BP < 90 for at least 30 minutes with evidence of poor end organ perfusion or need for inotropic support.

Question 6

What monitoring devices were used?

Answer 6

Swan, SV02, Echo , LVCPI

Question 7

RVCPI equation

Answer 7

CI x Mean PA presssure / 451.

Question 8

How many patients were in the final cohort?

Answer 8

74 (2010-2105) 400 were excluded

Question 9

Of the 74 patients ____ survived to Hospital discharge after successful IABP wean.

Answer 9

15 (20%)

Question 10

Of the 74 patients ____ underwent successful bridge to LVAD or OHT

Answer 10

38 ( 51%) (33 LVAD, 5 OHT)

Question 11

____ patients suffered an adverse event (death on IABP support or urgent escalation)

Answer 11

21 (28%)

Question 12

____ died with IABP support prior to any possible intervention

Answer 12

18

Question 13

______ required urgent escalation of MCS

Answer 13

3 (1 ECMO, 2 Impella)

Question 14

What percent of patients had ischemic cardiomyopathy vs non-Ischemic cardiomyopathy?

Answer 14

26% vs 74%

Question 15

By 12 hours, there was a significant decrease in ______ and ______ and significant increase in _____.

Answer 15

HR & SVR

CI

Question 16

there was also a slight but significant decrease in ____ ___ and un-augmented ______ blood pressures

Answer 16

Systemic systolic

Diastolic

Question 17

As expected with IABP support, this was accompanied by a slight trend towards increased ____ _____

Answer 17

Augmented MAP

Question 18

In concordance, there was a significant improvement in both right and left sided ____ ____ & ____ ____

Answer 18

Filling pressures and pulmonary pressures.

Question 19

Despite hemodynamic improvement, _____ % of this cohort suffered an adverse event

Answer 19

28%

Question 20

When did the adverse event group see a decline in CI?

Answer 20

24-48 hours after IABP placement

Question 21

What did they find?

Answer 21

That history of ischemic cardiomyopathy (ICM) and low baseline LVCPI were the most power predictors of adverse in-hospital events.

Question 22

What did LVCPI strongly predict?

Answer 22

Survival free of adverse events over the 28-days post IABP implant

Question 23

The vast majority of patients in this study underwent IABP placement to stabilize CS complicating what?

Answer 23

Known systolic heart failure

Question 24

What is systolic heart failure?

Answer 24

Heart failure with reduced EF.

Question 25

What is diastolic heart failure?

Answer 25

When the heart can’t properly fill with blood during its resting period, it’s called diastolic heart failure (or heart failure with preserved ejection fraction). This can happen when the heart muscle “bulks up” or thickens from being overworked — as a result of coronary artery disease or hypertension, for instance.Aug 3, 2016

Question 26

A third of the entire cohort suffered what?

Answer 26

In-hospital adverse event.

Question 27

This data suggest that _____ & history of _____ together are useful predictors of IABP hemodynamic failure

Answer 27

LVCPI & ICM

Question 28

Power is equal to the product of ____ & ____

Answer 28

Flow and pressure

Question 29

Patients on IABP had higher heart rates which may had effected what?

Answer 29

IABP efficiency.

Question 30

__________ can play a significant role in outcomes in cardiogenic shock.

Answer 30

Inflammation