ASAIO journal (American Society for Artificial Internal Organs : 1992) · 2026
Acute Effects of Impella 5.5 on Biventricular Filling and Pressure-Volume Area in Patients With Heart Failure Associated Cardiogenic Shock.
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Everett Kay D, Jain Pankaj, Lee Aaron, Miyashita Satoshi, Esposito Michele, Reyelt Lara, Said Christian, Barland Katherine, Picone Vincent, Faugno Anthony, Chweich Haval, Vest Amanda R, Kiernan Michael, Hong Edward, Brovman Ethan, Fox John, Kawabori Masashi, Kapur Navin K
Аннотация
Use of Impella 5.5 in patients with decompensated heart failure-associated cardiogenic shock (ADHF-CS) is increasing as a bridge to advanced therapies. The effects of maximal trans-valvular unloading on biventricular filling and pressure-volume area (PVA) in ADHF-CS are poorly understood. Nine patients with medically refractory ADHF-CS underwent Impella 5.5 placement with simultaneous invasive arterial, venous, and biventricular pressure-volume loop analysis. Acutely after Impella 5.5 activation, cardiac output (3.4 ± 0.5 vs. 5.0 ± 0.7 L/min, p = 0.0011), diastolic (67.2 ± 8.0 vs. 80.7 ± 9.7 mm Hg, p = 0.0044) and mean arterial pressures (77.9 ± 7.1 vs. 86.9 ± 10.4 mm Hg, p = 0.029) increased, compared to baseline. Left ventricular end-diastolic pressure (24.1 ± 6.7 vs. 16.8 ± 5.4 mm Hg, p = 0.0027), volume (262.1 ± 103.9 vs. 231.5 ± 104.3 ml, p = 0.0036), and PVA (21,913 ± 7,055 vs. 18,357 ± 7,758 mmHg·ml, p = 0.013) decreased. Right ventricular end-diastolic (12.4 ± 4.6 vs. 9.1 ± 3.8 mm Hg, p = 3.8E-5) and end-systolic pressure (42.1 ± 11.9 vs. 34.4 ± 11.1 mm Hg, p = 0.030) and PVA (6,303 ± 3,851 vs. 4,437 ± 2,473 mm Hg·ml, p = 0.027) also decreased. These findings suggest that maximal left ventricular unloading can acutely reduce biventricular filling pressures and PVA in patients with ADHF-CS.