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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Cardiogenic Shock Supported With VA-ECMO: Association Between cDPP3 Concentrations and Outcomes in a Post Hoc
Jolie Bruno1, Manon Durand2, Feriel Azibani3
1Université de Paris Cité, INSERM UMR - S 942, Cardiovascular Markers in Stress Condition (MASCOT), Paris, France; Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Insights
High circulating dipeptidyl peptidase-3 (cDPP3) levels before venoarterial extra corporeal membrane oxygenation (VA-ECMO) implantation indicate greater organ dysfunction and lower 30-day survival in cardiogenic shock patients. This biomarker
Area of Science:
- Cardiology
- Intensive Care Medicine
- Biomarker Research
Background:
- Circulating dipeptidyl peptidase-3 (cDPP3) is a protease with prognostic value in cardiogenic shock (CS).
- Its role in severe CS patients requiring venoarterial extra corporeal membrane oxygenation (VA-ECMO) remains uninvestigated.
Purpose of the Study:
- To investigate the prognostic value of cDPP3 in CS patients undergoing VA-ECMO.
- To assess the association between cDPP3 levels and organ dysfunction and 30-day survival.
Main Methods:
- Post hoc analysis of the prospective ADRECMO study (n=50).
- cDPP3 levels measured at VA-ECMO implantation, during VA-ECMO, and before explantation.
- Association analysis with organ dysfunction markers and 30-day survival.
Main Results:
- High cDPP3 (>73 ng/mL) at VA-ECMO implantation correlated with higher lactate, worse eGFR, higher AST, and greater norepinephrine dose.
- High pre-implantation cDPP3 was independently associated with lower 30-day survival (adjusted HR 4.13).
- No significant association found between later cDPP3 levels and survival.
Conclusions:
- Pre-implantation cDPP3 is a significant predictor of organ dysfunction severity.
- Elevated pre-implantation cDPP3 levels are linked to reduced 30-day survival in CS patients on VA-ECMO.
Background:
Circulating dipeptidyl peptidase-3 (cDPP3), a protease involved in angiotensin II degradation, has demonstrated prognostic properties, including organ dysfunction and/or mortality in patients with cardiogenic shock (CS) or at risk of developing CS. However, the prognostic properties of cDPP3 have not yet been investigated in patients with the most severe CS who require venoarterial extracorporeal membrane oxygenation (VA-ECMO).
Methods And Results:
This is a post hoc analysis of ADRECMO(Adrenoreceptor Expressions on Inflammatory Pattern in Refractory Cardiogenic Shock Under VA ECMO), a prospective cohort of 50 patients primarily designed to investigate the association between inflammation and adrenoreceptor expression in patients with CS receiving VA-ECMO. cDPP3 measurements were performed before VA-ECMO device implantation, 3-5 days later while VA-ECMO was ongoing, and before device explantation. Associations between cDPP3 concentrations at the predefined timepoints and level of organ dysfunction and 30-day survival were investigated. Forty-seven patients were analyzed. The median cDPP3 concentration was 73 ng/mL (interquartile range [IQR] 46-151 ng/mL) at VA-ECMO device implantation decreasing to 47 ng/mL (IQR 30-64 ng/mL) at days 3-5 and ng/mL 39 (IQR 29-50 ng/mL) on the day of device explantation (P < .001). Patients with a cDPP3 concentration of >73 ng/mL at VA-ECMO device implantation exhibited higher lactate concentrations (3.5 mmol/L [2.5-5.9 mmol/L] vs 1.9 mmol/L [1.3-3 mmol/L], P < .001), a worse estimated glomerular filtration rate (26 mL/min/1.73 m2 [15-40 mL/min/1.73 m2] vs 75 mL/min/1.73 m2 [48-102 mL/min/1.73 m2], P < .001), higher aspartate aminotransferase levels (1127 IU/L [587-1970 IU/L] vs 195 IU/L [50-646 IU/L], P < .001), and a greater norepinephrine cumulated dose (682 μg/kg [326-2258 μg/kg] vs 93 μg/kg [0-349 μg/kg], P = .001) compared with patients with lower cDPP3 concentrations. After adjustment for the cause of the CS, timing of VA-ECMO device implantation, and cardiac arrest before implantation, patients with a high cDPP3 concentration before implantation exhibited lower survival compared with patients with a low cDPP3 concentration (adjusted hazard ratio 4.13, 95% confidence interval 1.55-10.98). No significant association was observed between cDPP3 concentrations at later timepoints and 30-day survival.
Conclusions:
In a population of patients with CS on VA-ECMO, a high cDPP3 concentration measured before implantation was associated with greater severity of organ dysfunction and lower 30-day survival rates.
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