Hemodynamics of High-Risk Percutaneous Coronary Intervention With and Without Mechanical Circulatory Support: A Pilot Study With Pressure Volume Loop Analysis
Brener M, Rosenblum H, Basir M, Masoumi A, Kirtane AJ, O'Neill W, Karmpaliotis D, Burkhoff D, and Alqarqaz M. Hemodynamics of High-Risk Percutaneous Coronary Intervention With and Without Mechanical Circulatory Support: A Pilot Study With Pressure Volume Loop Analysis. J Am Coll Cardiol 2019; 74(13):B316.
J Am Coll Cardiol
Background: Changes in left ventricular (LV) contractility during high-risk percutaneous coronary intervention (HR-PCI) may foretell hemodynamic collapse that could be prevented by timely use of mechanical circulatory support (MCS). The purpose of this pilot study was to assess the feasibility and sensitivity of pressure volume loop (PVL) analysis to characterize changes in LV contractility and loading conditions during HR-PCI performed with and without Impella MCS (Abiomed; Danvers, Massachusetts). Methods: Nine patients underwent HR-PCI, 6 with Impella MCS. LV pressures and volumes were measured with a conductance catheter at key time points during the case. PVL were analyzed to detect changes in LV contractility and loading conditions. Results: Impella support resulted in changes in PVL shape (rectangular → triangular) related to the loss of isovolumic periods (Figure A). Increasing Impella speed setting resulted in a large degree of LV unloading (progressive decreases in LV volume) (Figure B). In some cases, balloon inflation resulted in decreased contractility that was not detectible from changes in blood pressure and that recovered on balloon deflation (Figures C and D). [Figure presented] Conclusion: PVL analysis was feasible during HR-PCI, including during Impella support. Alterations in LV contractility and load were detected in real time before changes in routinely measured vital signs were apparent. Future investigation will focus on whether PVL analysis can help risk stratify HR-PCI patients and determine conditions under which MCS minimizes post-procedural decreases in LV contractility.