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Unloading using Impella CP during profound cardiogenic shock caused by left ventricular failure in a large animal model: impact on the right ventricle
BACKGROUND AND AIM: This study aimed to assess right ventricular (RV) function during cardiogenic shock due to acute left ventricular (LV) failure, including during LV unloading with Impella CP and an added moderate dose of norepinephrine. METHODS: Cardiogenic shock was induced by injecting microsph...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7423825/ https://www.ncbi.nlm.nih.gov/pubmed/32785808 http://dx.doi.org/10.1186/s40635-020-00326-y |
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author | Josiassen, Jakob Helgestad, Ole Kristian Lerche Udesen, Nanne Louise Junker Banke, Ann Frederiksen, Peter Hartmund Hyldebrandt, Janus Adler Schmidt, Henrik Jensen, Lisette Okkels Hassager, Christian Ravn, Hanne Berg Møller, Jacob E. |
author_facet | Josiassen, Jakob Helgestad, Ole Kristian Lerche Udesen, Nanne Louise Junker Banke, Ann Frederiksen, Peter Hartmund Hyldebrandt, Janus Adler Schmidt, Henrik Jensen, Lisette Okkels Hassager, Christian Ravn, Hanne Berg Møller, Jacob E. |
author_sort | Josiassen, Jakob |
collection | PubMed |
description | BACKGROUND AND AIM: This study aimed to assess right ventricular (RV) function during cardiogenic shock due to acute left ventricular (LV) failure, including during LV unloading with Impella CP and an added moderate dose of norepinephrine. METHODS: Cardiogenic shock was induced by injecting microspheres in the left main coronary artery in 18 adult Danish Landrace pigs. Conductance catheters were placed in both ventricles and pressure-volume loops were recorded simultaneously. RESULTS: Cardiogenic shock due to LV failure also impaired RV performance, which was partially restored during haemodynamic support with Impella CP, as demonstrated by changes in the ventriculo-arterial coupling (Ea/Ees ratio) (baseline (median [Q1;Q3]) 1.2 [1.1;1.6]), cardiogenic shock (3.0 [2.4;4.5]), Impella CP (2.1 [1.3;2.7]) (p(Baseline vs CS) < 0.0001, p(CS vs Impella) = 0.001)). Impella CP support also improved RV stroke work (SW) (cardiogenic shock 333 [263;530] vs Impella CP (830 [717;1121]) (p < 0.001). Moderate norepinephrine infusion concomitant with Impella CP further improved RV SW (Impella CP (818 [751;1065]) vs Impella CP+moderate norepinephrine (1231 [1142;1335]) (p = 0.01)) but at the expense of an increase in LV SW (Impella CP (858 [555;1392]) vs Impella CP+moderate norepinephrine (2101 [1024;2613]) (p = 0.04)). CONCLUSIONS: The Impella CP provided efficient LV unloading, improved RV function, and end-organ perfusion. Moderate doses of norepinephrine during Impella support further improved RV function, but at the expense of an increase in SW of the failing LV. |
format | Online Article Text |
id | pubmed-7423825 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-74238252020-08-19 Unloading using Impella CP during profound cardiogenic shock caused by left ventricular failure in a large animal model: impact on the right ventricle Josiassen, Jakob Helgestad, Ole Kristian Lerche Udesen, Nanne Louise Junker Banke, Ann Frederiksen, Peter Hartmund Hyldebrandt, Janus Adler Schmidt, Henrik Jensen, Lisette Okkels Hassager, Christian Ravn, Hanne Berg Møller, Jacob E. Intensive Care Med Exp Research BACKGROUND AND AIM: This study aimed to assess right ventricular (RV) function during cardiogenic shock due to acute left ventricular (LV) failure, including during LV unloading with Impella CP and an added moderate dose of norepinephrine. METHODS: Cardiogenic shock was induced by injecting microspheres in the left main coronary artery in 18 adult Danish Landrace pigs. Conductance catheters were placed in both ventricles and pressure-volume loops were recorded simultaneously. RESULTS: Cardiogenic shock due to LV failure also impaired RV performance, which was partially restored during haemodynamic support with Impella CP, as demonstrated by changes in the ventriculo-arterial coupling (Ea/Ees ratio) (baseline (median [Q1;Q3]) 1.2 [1.1;1.6]), cardiogenic shock (3.0 [2.4;4.5]), Impella CP (2.1 [1.3;2.7]) (p(Baseline vs CS) < 0.0001, p(CS vs Impella) = 0.001)). Impella CP support also improved RV stroke work (SW) (cardiogenic shock 333 [263;530] vs Impella CP (830 [717;1121]) (p < 0.001). Moderate norepinephrine infusion concomitant with Impella CP further improved RV SW (Impella CP (818 [751;1065]) vs Impella CP+moderate norepinephrine (1231 [1142;1335]) (p = 0.01)) but at the expense of an increase in LV SW (Impella CP (858 [555;1392]) vs Impella CP+moderate norepinephrine (2101 [1024;2613]) (p = 0.04)). CONCLUSIONS: The Impella CP provided efficient LV unloading, improved RV function, and end-organ perfusion. Moderate doses of norepinephrine during Impella support further improved RV function, but at the expense of an increase in SW of the failing LV. Springer International Publishing 2020-08-12 /pmc/articles/PMC7423825/ /pubmed/32785808 http://dx.doi.org/10.1186/s40635-020-00326-y Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Research Josiassen, Jakob Helgestad, Ole Kristian Lerche Udesen, Nanne Louise Junker Banke, Ann Frederiksen, Peter Hartmund Hyldebrandt, Janus Adler Schmidt, Henrik Jensen, Lisette Okkels Hassager, Christian Ravn, Hanne Berg Møller, Jacob E. Unloading using Impella CP during profound cardiogenic shock caused by left ventricular failure in a large animal model: impact on the right ventricle |
title | Unloading using Impella CP during profound cardiogenic shock caused by left ventricular failure in a large animal model: impact on the right ventricle |
title_full | Unloading using Impella CP during profound cardiogenic shock caused by left ventricular failure in a large animal model: impact on the right ventricle |
title_fullStr | Unloading using Impella CP during profound cardiogenic shock caused by left ventricular failure in a large animal model: impact on the right ventricle |
title_full_unstemmed | Unloading using Impella CP during profound cardiogenic shock caused by left ventricular failure in a large animal model: impact on the right ventricle |
title_short | Unloading using Impella CP during profound cardiogenic shock caused by left ventricular failure in a large animal model: impact on the right ventricle |
title_sort | unloading using impella cp during profound cardiogenic shock caused by left ventricular failure in a large animal model: impact on the right ventricle |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7423825/ https://www.ncbi.nlm.nih.gov/pubmed/32785808 http://dx.doi.org/10.1186/s40635-020-00326-y |
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