Left Ventricular Unloading in Nonischemic Dilated Cardiomyopathy Improves Coronary Haemodynamic Reserve

Area of Science:

• Cardiology
• Cardiovascular Devices
• Hemodynamics

Background:

• The Impella CP is a catheter-based ventricular assist device used for cardiogenic shock and high-risk percutaneous coronary interventions (PCI).
• The impact of Impella CP on coronary flow dynamics, measured by intracoronary continuous thermodilution, requires further quantification.

Purpose of the Study:

• To evaluate the effect of percutaneous ventricular unloading (PVU) with Impella CP on coronary flow reserve (CFR) and microvascular resistance reserve (MRR).
• To assess these hemodynamic parameters in patients with severe nonischemic dilated cardiomyopathy undergoing autologous bone-marrow derived mononuclear cell (BMMNC) infusion.

Main Methods:

• Coronary flow (Q) was measured using intracoronary continuous thermodilution at rest (Qrest) and during hyperemia (Qhyper).
• Measurements were taken in the left anterior descending (LAD) artery before and after PVU with Impella CP using a specialized pressure/thermistor coronary guidewire.
• Coronary flow reserve (CFR) and microvascular resistance reserve (MRR) were calculated post-procedure.

Main Results:

• Initiation of LV unloading with Impella CP led to a significant increase in CFR (2.72 to 3.9, p=0.049) and MRR (3.09 to 4.50, p=0.022).
• A decrease in mean Qrest and an increase in mean Qhyper were observed post-PVU.

Conclusions:

• Percutaneous ventricular unloading with Impella CP significantly enhances coronary hemodynamic reserve, as indicated by increased CFR and MRR.
• Further validation in larger patient cohorts is warranted to confirm these hemodynamic improvements.