Monitoring a Mystery: The Unknown Right Ventricle during Left Ventricular Unloading with Impella in Patients with Cardiogenic Shock
<b>Background</b>: Right ventricular (RV) dysfunction or failure occurs in more than 30% of patients in cardiogenic shock (CS). However, the importance of timely diagnosis of prognostically relevant impairment of RV function is often underestimated. Moreover, data regarding the impact of...
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-02-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/13/5/1265 |
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| author | Birgit Markus Julian Kreutz Giorgios Chatzis Styliani Syntila Maryana Choukeir Bernhard Schieffer Nikolaos Patsalis |
| author_facet | Birgit Markus Julian Kreutz Giorgios Chatzis Styliani Syntila Maryana Choukeir Bernhard Schieffer Nikolaos Patsalis |
| author_sort | Birgit Markus |
| collection | DOAJ |
| description | <b>Background</b>: Right ventricular (RV) dysfunction or failure occurs in more than 30% of patients in cardiogenic shock (CS). However, the importance of timely diagnosis of prognostically relevant impairment of RV function is often underestimated. Moreover, data regarding the impact of mechanical circulatory support like the Impella on RV function are rare. Here, we investigated the effects of the left ventricular (LV) Impella on RV function. Moreover, we aimed to identify the most optimal and the earliest applicable parameter for bedside monitoring of RV function by comparing the predictive abilities of three common RV function parameters: the pulmonary artery pulsatility index (PAPi), the ratio of right atrial pressure to pulmonary capillary wedge pressure (RA/PCWP), and the right ventricular stroke work index (RVSWI). <b>Methods</b>: The data of 50 patients with CS complicating myocardial infarction, supported with different flow levels of LV Impella, were retrospectively analyzed. <b>Results:</b> Enhancing Impella flow (1.5 to 2.5 L/min ± 0.4 L/min) did not lead to a significant variation in PAPi (<i>p</i> = 0.717), RA/PCWP (<i>p</i> = 0.601), or RVSWI (<i>p</i> = 0.608), indicating no additional burden for the RV. PAPi revealed the best ability to connect RV function with global hemodynamic parameters, i.e., cardiac index (CI; <i>p</i> < 0.001, 95% CI: 0.181–0.663), pulmonary capillary wedge pressure (PCWP; <i>p</i> = 0.005, 95% CI: −6.721–−1.26), central venous pressure (CVP; <i>p</i> < 0.001, 95% CI: −7.89–5.575), and indicators of tissue perfusion (central venous oxygen saturation (SvO<sub>2</sub>); <i>p</i> = 0.008, 95% CI: 1.096–7.196). <b>Conclusions:</b> LV Impella does not impair RV function. Moreover, PAPi seems to be to the most effective and valid predictor for early bedside monitoring of RV function. |
| first_indexed | 2024-04-25T00:26:51Z |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-04-25T00:26:51Z |
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| spelling | doaj.art-9f602ab0200844718f253f5bed4ed6072024-03-12T16:47:46ZengMDPI AGJournal of Clinical Medicine2077-03832024-02-01135126510.3390/jcm13051265Monitoring a Mystery: The Unknown Right Ventricle during Left Ventricular Unloading with Impella in Patients with Cardiogenic ShockBirgit Markus0Julian Kreutz1Giorgios Chatzis2Styliani Syntila3Maryana Choukeir4Bernhard Schieffer5Nikolaos Patsalis6Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35037 Marburg, GermanyDepartment of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35037 Marburg, GermanyDepartment of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35037 Marburg, GermanyDepartment of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35037 Marburg, GermanyDepartment of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35037 Marburg, GermanyDepartment of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35037 Marburg, GermanyDepartment of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35037 Marburg, Germany<b>Background</b>: Right ventricular (RV) dysfunction or failure occurs in more than 30% of patients in cardiogenic shock (CS). However, the importance of timely diagnosis of prognostically relevant impairment of RV function is often underestimated. Moreover, data regarding the impact of mechanical circulatory support like the Impella on RV function are rare. Here, we investigated the effects of the left ventricular (LV) Impella on RV function. Moreover, we aimed to identify the most optimal and the earliest applicable parameter for bedside monitoring of RV function by comparing the predictive abilities of three common RV function parameters: the pulmonary artery pulsatility index (PAPi), the ratio of right atrial pressure to pulmonary capillary wedge pressure (RA/PCWP), and the right ventricular stroke work index (RVSWI). <b>Methods</b>: The data of 50 patients with CS complicating myocardial infarction, supported with different flow levels of LV Impella, were retrospectively analyzed. <b>Results:</b> Enhancing Impella flow (1.5 to 2.5 L/min ± 0.4 L/min) did not lead to a significant variation in PAPi (<i>p</i> = 0.717), RA/PCWP (<i>p</i> = 0.601), or RVSWI (<i>p</i> = 0.608), indicating no additional burden for the RV. PAPi revealed the best ability to connect RV function with global hemodynamic parameters, i.e., cardiac index (CI; <i>p</i> < 0.001, 95% CI: 0.181–0.663), pulmonary capillary wedge pressure (PCWP; <i>p</i> = 0.005, 95% CI: −6.721–−1.26), central venous pressure (CVP; <i>p</i> < 0.001, 95% CI: −7.89–5.575), and indicators of tissue perfusion (central venous oxygen saturation (SvO<sub>2</sub>); <i>p</i> = 0.008, 95% CI: 1.096–7.196). <b>Conclusions:</b> LV Impella does not impair RV function. Moreover, PAPi seems to be to the most effective and valid predictor for early bedside monitoring of RV function.https://www.mdpi.com/2077-0383/13/5/1265cardiogenic shockleft ventricular Impellaright ventricular functionpredictors of RV function |
| spellingShingle | Birgit Markus Julian Kreutz Giorgios Chatzis Styliani Syntila Maryana Choukeir Bernhard Schieffer Nikolaos Patsalis Monitoring a Mystery: The Unknown Right Ventricle during Left Ventricular Unloading with Impella in Patients with Cardiogenic Shock Journal of Clinical Medicine cardiogenic shock left ventricular Impella right ventricular function predictors of RV function |
| title | Monitoring a Mystery: The Unknown Right Ventricle during Left Ventricular Unloading with Impella in Patients with Cardiogenic Shock |
| title_full | Monitoring a Mystery: The Unknown Right Ventricle during Left Ventricular Unloading with Impella in Patients with Cardiogenic Shock |
| title_fullStr | Monitoring a Mystery: The Unknown Right Ventricle during Left Ventricular Unloading with Impella in Patients with Cardiogenic Shock |
| title_full_unstemmed | Monitoring a Mystery: The Unknown Right Ventricle during Left Ventricular Unloading with Impella in Patients with Cardiogenic Shock |
| title_short | Monitoring a Mystery: The Unknown Right Ventricle during Left Ventricular Unloading with Impella in Patients with Cardiogenic Shock |
| title_sort | monitoring a mystery the unknown right ventricle during left ventricular unloading with impella in patients with cardiogenic shock |
| topic | cardiogenic shock left ventricular Impella right ventricular function predictors of RV function |
| url | https://www.mdpi.com/2077-0383/13/5/1265 |
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