Aortic Pulsatility Index Predicts Native Recovery in Patients With Cardiogenic Shock Supported by Intra-aortic...

Area of Science:

• Cardiology
• Critical Care Medicine
• Biomedical Engineering

Background:

• The intra-aortic balloon pump (IABP) is a standard therapy for cardiogenic shock (CS).
• Validated clinical markers for predicting native heart recovery in CS patients on IABP support are lacking.
• Identifying predictors of native recovery is crucial for optimizing treatment strategies and patient outcomes.

Purpose of the Study:

• To evaluate clinical and hemodynamic predictors of survival to hospital discharge with native heart recovery in CS patients requiring IABP.
• To introduce and validate a novel hemodynamic marker, the assisted aortic pulsatility index (API), for predicting native recovery.

Main Methods:

• Retrospective analysis of 267 consecutive CS patients requiring IABP support between January 2021 and November 2024.
• Hemodynamic variables, including assisted systolic blood pressure, assisted diastolic blood pressure, and pulmonary capillary wedge pressure (PCWP), were recorded at baseline, initial IABP support, and final IABP support.
• The assisted aortic pulsatility index (API) was defined as (assisted systolic blood pressure - assisted diastolic blood pressure) / PCWP.

Main Results:

• Eighty patients were included in the final analysis; in-hospital mortality was 31%.
• Native recovery occurred in 40% of patients, while 29% were bridged to advanced therapies (transplant or LVAD).
• Multivariable analysis identified final assisted API (OR 3.283, P=0.002) and acute myocardial infarction (AMI) presentation (OR 18.12, P=0.016) as significant predictors of native recovery.
• A receiver-operating characteristic curve analysis showed the final assisted API to be a strong predictor (C-statistic: 0.77, P < 0.001).
• An assisted API cutoff > 1.7 demonstrated 81% sensitivity and 64% specificity for predicting survival to native recovery.

Conclusions:

• The assisted aortic pulsatility index (API) is a novel, sensitive, and specific hemodynamic marker for predicting native recovery in CS patients supported by IABPs.
• This marker can aid clinicians in assessing the potential for native heart function recovery and guiding therapeutic decisions.