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Right Ventricular Dysfunction in Patients Undergoing High-Risk PCI with Impella
Karl-Philipp Rommel1, Guillaume Bonnet2, Lavanya Bellumkonda3
1Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany, University Medical Center Mainz, Mainz, Germany; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.
Journal of Cardiac Failure
|October 10, 2024
Summary
Right ventricular dysfunction (RVD) in patients undergoing high-risk percutaneous coronary intervention (HRPCI) with Impella support is linked to worse long-term outcomes. Despite effective revascularization, RVD predicts increased 90-day MACCE and one-year mortality.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Imaging
Background:
- Right ventricular dysfunction (RVD) is a key prognostic indicator in heart failure.
- The effect of RVD on outcomes in high-risk percutaneous coronary intervention (HRPCI) with Impella support remains unclear.
Purpose of the Study:
- To investigate the impact of baseline RVD on clinical outcomes in patients undergoing Impella-supported HRPCI.
- To assess procedural success, short-term, and long-term prognoses in relation to RVD status.
Main Methods:
- Patients from the PROTECT III study were stratified by RVD presence, assessed via echocardiography.
- Defined RVD criteria included fractional area change < 35%, tricuspid annular plane systolic excursion < 17 mm, or S-wave < 9.5 cm/s.
- Evaluated procedural outcomes, 90-day major adverse cardiac and cerebrovascular events (MACCE), and 1-year mortality.
Main Results:
- 124 of 239 patients had RVD, associated with lower LVEF and higher BUN.
- No significant differences in hypotensive episodes, Impella support duration, or in-hospital mortality.
- Higher 90-day MACCE rates and RVD as a predictor of 1-year mortality were observed.
Conclusions:
- RVD in Impella-supported HRPCI patients indicates more advanced biventricular failure.
- Impella facilitates effective revascularization, even with RVD.
- RVD is associated with unfavorable long-term prognoses despite procedural success.
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