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Hemodynamics and its predictors during Impella-protected PCI in high risk patients with reduced ejection fraction
Giulio Russo1, Francesco Burzotta1, Domenico D'Amario1
1Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Insights
Impella (IMP) support during percutaneous coronary intervention (PCI) in patients with reduced ejection fraction (EF) maintains vital organ perfusion despite pressure drops. Higher coronary disease burden and left ventricular volumes predict critical pressure decreases during IMP-protected PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Hemodynamics
Background:
- Percutaneous ventricular assistance with Impella (IMP) is an emerging strategy for patients with reduced left-ventricular ejection fraction (LVEF) undergoing percutaneous coronary intervention (PCI).
- Hemodynamic behavior during IMP-protected PCI is not well understood.
- Limited data exists on the safety and efficacy of IMP during PCI in this high-risk population.
Purpose of the Study:
- To investigate the hemodynamic changes during Impella-protected PCI in patients with reduced LVEF.
- To identify predictors of critical blood pressure drops during IMP-assisted PCI.
- To assess the safety and feasibility of IMP support during complex PCI procedures.
Main Methods:
- A retrospective review of hemodynamic data from 37 patients with multivessel disease and impaired LVEF undergoing elective IMP-protected PCI.
- Analysis of Impella console data, including motor speed, systolic blood pressure (SBP), and mean blood pressure (MBP).
- Primary endpoints included critical SBP drop (≥20 mmHg to ≤90 mmHg) and critical MBP drop (to ≤60 mmHg). Coronary artery disease burden was assessed using the British Cardiovascular Intervention Society jeopardy score (BCIS-JS).
Main Results:
- No Impella motor drops occurred during a mean assistance duration of 254 ± 549 minutes.
- Systolic and mean blood pressure significantly decreased during PCI, but SBP remained above 78 mmHg in all patients.
- Critical SBP and MBP drops occurred in 10.8% of patients. BCIS-JS score was the sole significant predictor of SBP drop, while BCIS-JS and left ventricular end-diastolic volume predicted MBP drop.
Conclusions:
- IMP-protected PCI in patients with reduced EF leads to significant but generally well-tolerated pressure decreases.
- Vital organ perfusion is maintained despite hemodynamic fluctuations during IMP-assisted PCI.
- Higher coronary artery disease burden (BCIS-JS) and left ventricular volumes are associated with an increased risk of critical pressure drops.
Background:
Percutaneous ventricular-assistance by Impella (IMP) represents an emerging strategy to manage patients with reduced left-ventricular (LV) ejection-fraction (EF) undergoing percutaneous-coronary-intervention (PCI). The hemodynamic behave during IMP-protected PCI has been scarcely investigated.
Methods:
We reviewed the IMP console's function and hemodynamic data (which are continuously recorded during assistance) in a consecutive series of 37 patients who underwent elective IMP-protected PCI in two high-volume centers. All patients had multivessel disease and impaired LVEF. Coronary artery disease burden was graded using the British-Cardiovascular-Intervention-Society jeopardy-score (BCIS-JS) score. IMP motor speed and pressure signals (systolic blood pressure, SBP, and mean blood pressure, MBP) were analyzed. Primary hemodynamic end-points were "critical systolic blood pressure (SBP) drop" (SBP decrease ≥ 20 mm Hg reaching ≤90 mm Hg values) and "critical mean blood pressure (MBP) drop" (MBP decrease reaching ≤60 mm Hg).
Results:
Over mean assistance duration of 254 ± 549 min, no IMP motor drop occurred. During PCI, SBP and MBP significantly decreased but all patients had SBP values >78 mm Hg. Critical SBP and MBP drops occurred in 10.8% of patients. Among all baseline and procedural characteristics, BCIS-JS was the only significant predictor of SBP drop (p = 0.001) while BCIS-JS and LV end-diastolic volume significantly predicted MBP drop (p = 0.001 for both).
Conclusions:
In patients with reduced EF undergoing IMP-protected PCI, a significant pressure decrease occurs during PCI but pressure is systematically maintained at levels warranting vital organ perfusion. Critical pressure drops during PCI occur in some patients with higher jeopardized myocardium and left ventricular diastolic volumes.
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