Interventions for valvular disease and heart failure

Primary intra-aortic balloon support versus inotropes for decompensated heart failure and low output: a randomised trial

EuroIntervention 2019;15:586-593. DOI: 10.4244/EIJ-D-19-00254

Corstiaan den Uil
Corstiaan A. den Uil1,2, MD, PhD; Nicolas M. Van Mieghem1, MD, PhD; Marcelo B. Bastos1, MD; Lucia S. Jewbali1,2, MD; Mattie J. Lenzen1, PhD; Annemarie E. Engstrom1,2, MD, PhD; Jeroen J.H. Bunge1,2, MD; Jasper J. Brugts1, MD, PhD; Olivier C. Manintveld1, MD, PhD; Joost Daemen1, MD, PhD; Jeroen M. Wilschut1, MD; Felix Zijlstra1, MD, PhD; Alina A. Constantinescu1, MD, DPhil
1. Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; 2. Department of Intensive Care Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands

Aims: The haemodynamic effects of primary implantation of an intra-aortic balloon pump (IABP) versus inotropes in decompensated heart failure and low output (DHF-LO), but without an acute coronary syndrome, have not been investigated. We therefore aimed to investigate the effect of primary IABP implantation as compared to inotropes on haemodynamics in DHF-LO with no acute ischaemia.

Methods and results: Patients (n=32) with DHF-LO despite IV diuretics were randomised to primary 50 mL IABP or inotropes (INO: enoximone or dobutamine). The primary endpoint was the improvement of organ perfusion assessed by ∆ mixed-venous oxygen saturation (SvO2) at 3 hours; secondary endpoints included ∆ cardiac power output (CPO), NT-proBNP proportional change, cumulative fluid balance and ∆ dyspnoea severity score, all at 48 hours. Data are presented as median (IQR). Patients were 60 (48-69) years old and 72% were male. Baseline SvO2 was 44 (39-53)%. ∆SvO2 was higher in the IABP group (+17 [+9; +24] vs. +5 [+2; +9]%, p<0.05). IABP patients had a higher ∆CPO, a greater relative reduction in NT-proBNP, a more negative cumulative fluid balance, and a greater reduction in dyspnoea severity score. There were no IABP-related serious adverse events (SAEs). Thirty-day mortality was 23% (IABP) vs. 44% (INO).

Conclusions: Primary circulatory support by IABP showed a significant increase in improved organ perfusion assessed by SvO2.

Sign in to read and download the full article

Forgot your password?

No account yet?
Sign up for free!

Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from PCRonline.com

acute heart failuredepressed left ventricular functiondilated non-ischaemic cardiomyopathyfemoralresistant cardiac insufficiencyventricular assist device
Read next article
Acute and long-term relocation of minimal lumen area after bioresorbable scaffold or metallic stent implantation

Latest news