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

PurposeIn chronic heart failure patients who develop cardiogenic shock (CS), intra-aortic balloon pump (IABP) therapy may improve hemodynamics and be useful as a bridge to definitive therapies such as durable left ventricular assist device (LVAD) or heart transplant (OHT). We explore whether patients with cardiac amyloidosis (CA) and CS derive similar benefits and describe the hemodynamic response after IABP in CA.MethodsWe retrospectively identified consecutive patients at our institution with a diagnosis of either light-chain (AL) or transthyretin (ATTR)-CA and who were admitted to the intensive care unit with CS. Patients were included if they had an indwelling pulmonary artery catheter and an IABP placed during admission, and were excluded if IABP was placed during heart transplant (OHT) or for CS due to acute myocardial infarction (AMI-CS). First available hemodynamic parameters before and after IABP placement were collected.ResultsA total of 23 patients with CA and CS were identified. Survival at 1-year was 73% and most patients (65%) were successfully bridged to OHT, while one was bridged to LVAD. 3 patients had in-hospital mortality despite IABP therapy. Median time to transplant was 31 days, IQR [23 - 44]. Patients experienced significant increases in mean arterial pressure (MAP), cardiac index (CI), and cardiac power index (CPI) post-IABP. Filling pressures, including mean right atrial pressure (RA), pulmonary artery diastolic pressure (PADP), and pulmonary capillary wedge pressure (PCWP) were all significantly reduced post-IABP. Univariate screen revealed larger left ventricular internal end-diastolic diameter (LVIDD) predicted higher CPI post-IABP (r2= 0.20 [0.041-0.846], P=0.03).ConclusionIABP therapy significantly improved CI as well as left and right sided ventricular filling pressures in CA patients with chronic heart failure who developed CS and may have a role in this population, particularly as a bridge to OHT. In chronic heart failure patients who develop cardiogenic shock (CS), intra-aortic balloon pump (IABP) therapy may improve hemodynamics and be useful as a bridge to definitive therapies such as durable left ventricular assist device (LVAD) or heart transplant (OHT). We explore whether patients with cardiac amyloidosis (CA) and CS derive similar benefits and describe the hemodynamic response after IABP in CA. We retrospectively identified consecutive patients at our institution with a diagnosis of either light-chain (AL) or transthyretin (ATTR)-CA and who were admitted to the intensive care unit with CS. Patients were included if they had an indwelling pulmonary artery catheter and an IABP placed during admission, and were excluded if IABP was placed during heart transplant (OHT) or for CS due to acute myocardial infarction (AMI-CS). First available hemodynamic parameters before and after IABP placement were collected. A total of 23 patients with CA and CS were identified. Survival at 1-year was 73% and most patients (65%) were successfully bridged to OHT, while one was bridged to LVAD. 3 patients had in-hospital mortality despite IABP therapy. Median time to transplant was 31 days, IQR [23 - 44]. Patients experienced significant increases in mean arterial pressure (MAP), cardiac index (CI), and cardiac power index (CPI) post-IABP. Filling pressures, including mean right atrial pressure (RA), pulmonary artery diastolic pressure (PADP), and pulmonary capillary wedge pressure (PCWP) were all significantly reduced post-IABP. Univariate screen revealed larger left ventricular internal end-diastolic diameter (LVIDD) predicted higher CPI post-IABP (r2= 0.20 [0.041-0.846], P=0.03). IABP therapy significantly improved CI as well as left and right sided ventricular filling pressures in CA patients with chronic heart failure who developed CS and may have a role in this population, particularly as a bridge to OHT.