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.

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