Hemodynamics and its predictors during Impella-protected PCI in high risk patients with reduced ejection fraction

Giulio Russo, Francesco Burzotta, Domenico D'Amario, Flavio Ribichini, Anna Piccoli, Lazzaro Paraggio, Leonardo Previ, Gabriele Pesarini, Italo Porto, Antonio Maria Leone, Giampaolo Niccoli, Cristina Aurigemma, Diana Verdirosi, Carlo Trani, Filippo Crea

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Abstract

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.

Original languageEnglish
Pages (from-to)221-225
Number of pages5
JournalInternational Journal of Cardiology
Volume274
DOIs
Publication statusE-pub ahead of print - 2018

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Percutaneous Coronary Intervention
Hemodynamics
Blood Pressure
Pressure
Stroke Volume

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Hemodynamics and its predictors during Impella-protected PCI in high risk patients with reduced ejection fraction. / Russo, Giulio; Burzotta, Francesco; D'Amario, Domenico; Ribichini, Flavio; Piccoli, Anna; Paraggio, Lazzaro; Previ, Leonardo; Pesarini, Gabriele; Porto, Italo; Leone, Antonio Maria; Niccoli, Giampaolo; Aurigemma, Cristina; Verdirosi, Diana; Trani, Carlo; Crea, Filippo.

In: International Journal of Cardiology, Vol. 274, 2018, p. 221-225.

Research output: Contribution to journalArticle

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abstract = "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.",
author = "Giulio Russo and Francesco Burzotta and Domenico D'Amario and Flavio Ribichini and Anna Piccoli and Lazzaro Paraggio and Leonardo Previ and Gabriele Pesarini and Italo Porto and Leone, {Antonio Maria} and Giampaolo Niccoli and Cristina Aurigemma and Diana Verdirosi and Carlo Trani and Filippo Crea",
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TY - JOUR

T1 - Hemodynamics and its predictors during Impella-protected PCI in high risk patients with reduced ejection fraction

AU - Russo, Giulio

AU - Burzotta, Francesco

AU - D'Amario, Domenico

AU - Ribichini, Flavio

AU - Piccoli, Anna

AU - Paraggio, Lazzaro

AU - Previ, Leonardo

AU - Pesarini, Gabriele

AU - Porto, Italo

AU - Leone, Antonio Maria

AU - Niccoli, Giampaolo

AU - Aurigemma, Cristina

AU - Verdirosi, Diana

AU - Trani, Carlo

AU - Crea, Filippo

N1 - Copyright © 2018 Elsevier B.V. All rights reserved.

PY - 2018

Y1 - 2018

N2 - 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.

AB - 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.

U2 - 10.1016/j.ijcard.2018.07.064

DO - 10.1016/j.ijcard.2018.07.064

M3 - Article

C2 - 30057165

VL - 274

SP - 221

EP - 225

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -