Right Ventricular Dysfunction in Patients Undergoing High-Risk PCI with Impella
Recommended Citation
Rommel KP, Bonnet G, Bellumkonda L, Lansky AJ, Zhao D, Thompson JB, Zhang Y, Redfors B, Lurz PC, Granada JF, Bharadwaj AS, Basir MB, O'Neill WW, and Burkhoff D. Right Ventricular Dysfunction in Patients Undergoing High-Risk PCI with Impella. J Card Fail 2024; 30(10):1244-1254.
Document Type
Article
Publication Date
10-1-2024
Publication Title
Journal of cardiac failure
Abstract
BACKGROUND: Right ventricular dysfunction (RVD) is an important prognostic factor in several cardiac conditions, including acute and chronic heart failure. The impact of baseline RVD on clinical outcomes of patients undergoing high-risk percutaneous coronary intervention (HRPCI) supported by Impella is unknown.
METHODS: Patients from the single-arm, multicenter PROTECT III study of Impella-supported HRPCI were stratified based on the presence or absence of RVD. RVD was quantitatively assessed by an echocardiography core laboratory and was defined as fractional area change < 35%, tricuspid annular plane systolic excursion < 17 mm or pulsed-wave Doppler S-wave of the lateral tricuspid annulus < 9.5 cm/s. Procedural outcomes, 90-day major adverse cardiac and cerebrovascular events (MACCE: the composite of all-cause mortality, myocardial infarction, stroke/TIA, and repeat revascularization), and 1-year mortality were assessed.
RESULTS: Of the 239 patients who underwent RV function assessment, 124 were found to have RVD. Lower left ventricular ejection fraction, higher blood urea nitrogen levels, and more severe RV dilation were independently associated with RVD. The incidence of hypotensive episodes during PCI, the proportion of patients requiring prolonged Impella support, the completeness of revascularization, and the rate of in-hospital mortality did not differ significantly between patients with vs without RVD. However, 90-day MACCE rates were higher in those with RVD, and RVD was a robust predictor of 1-year mortality in multivariable Cox-regression analyses.
CONCLUSION: In patients undergoing HRPCI with Impella, RVD was associated with more advanced biventricular failure. The use of Impella support during HRPCI facilitated effective revascularization, even in those with concomitant RVD. Nevertheless, RVD was associated with unfavorable long-term prognoses.
Medical Subject Headings
Humans; Male; Female; Percutaneous Coronary Intervention; Heart-Assist Devices; Aged; Ventricular Dysfunction, Right; Middle Aged; Hospital Mortality; Treatment Outcome; Risk Factors; Follow-Up Studies
PubMed ID
39389734
Volume
30
Issue
10
First Page
1244
Last Page
1254
