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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Improved microcirculation in patients with an acute ST-elevation myocardial infarction treated with the Impella LP2.5
Kayan Lam1, Krischan D Sjauw, José P S Henriques
1Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Insights
Percutaneous coronary intervention (PCI) with Impella support improved microcirculation in ST-elevation myocardial infarction (STEMI) patients. Sidestream dark field (SDF) imaging showed Impella group microcirculation normalized, unlike the control group.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Imaging
Background:
- ST-element elevation myocardial infarction (STEMI) requires hemodynamic support during percutaneous coronary intervention (PCI).
- Continuous flow pumps may disrupt pulsatile circulation and microvascular function.
- Sidestream dark field (SDF) imaging visualizes microvascular structure and function, assessing circulatory support efficacy.
Purpose of the Study:
- To evaluate the impact of Impella LP2.5 percutaneous left ventricular support on sublingual microcirculation in STEMI patients undergoing PCI.
- To compare microcirculatory function between STEMI patients with and without Impella support.
- To assess the utility of SDF imaging in monitoring myocardial recovery and organ perfusion post-PCI.
Main Methods:
- SDF imaging assessed sublingual microcirculation (MC) in six anterior STEMI patients post-PCI.
- Three patients received Impella LP2.5 support (Impella group), three received no support (control group).
- MC was measured at baseline and 72 hours post-PCI, analyzing microvascular flow index (MFI) and perfused vessel density (PVD).
Main Results:
- The Impella group achieved normal microcirculation, comparable to healthy controls, with improved left ventricular function.
- Functional capillary density (PVD) was similar in both groups and above healthy controls.
- Microcirculatory flow quality (MFI) reached healthy control levels only in the Impella group.
Conclusions:
- Impella LP2.5 support improved microcirculation in STEMI patients to healthy levels, as assessed by SDF imaging.
- Microcirculation remained suboptimal in the control group 72 hours post-PCI.
- Sublingual SDF imaging can monitor effective myocardial recovery and optimize organ perfusion after PCI.
Background:
Circulatory support during percutaneous coronary intervention (PCI) in patients with ST-element elevation myocardial infarction (STEMI) aims at maintaining hemodynamic stability and organ perfusion. However, continuous flow pumps may interfere with the normal pulsatile circulation and the microcirculatory function. Sidestream dark field (SDF) imaging allows the visualization of microvascular structure and function of tissue and may provide information regarding the efficacy of the circulatory support.
Methods:
Sidestream dark field was used to study the sublingual microcirculation (MC) in six anterior STEMI patients treated with PCI; three patients received Impella LP2.5 percutaneous left ventricular support (Impella group) and three patients received no support (control group). MC was assessed at baseline, at 24, 48 and 72 h after PCI. Data were analyzed using a validated scoring method and the microvascular flow index (MFI) and perfused vessel density (PVD) were calculated. MC of three healthy controls was used as normalized standard.
Results:
Normal MC depending on both functional capillary density (PVD) and flow velocity or quality (MFI), as observed in healthy controls, was only achieved in the Impella group and paralleled improvement in LV function. Functional capillary density in the control and Impella groups were respectively equal and above the level of healthy controls. The quality of microcirculatory flow only in the Impella group reached values of healthy controls.
Conclusions:
Microcirculation assessed by SDF improved in STEMI patients treated with the Impella LP2.5 to levels observed in healthy persons and remained suboptimal after 72 h in patients without support. Sublingual SDF to assess MC may serve as a monitor of effective myocardial recovery after PCI and optimization of organ perfusion.
