TCT CONNECT-176 Diastolic Suction Alarms Are an Early Marker for Right Ventricular Failure in the Setting of Left Ventricular Mechanical Circulatory Support
Basir M, Gorgis S, Lemor A, Ghiu I, Kelley R, McRae T, Khuddus M, Sharma R, Lim M, Nsair A, Wohns D, Mehra A, Lin L, Pinto D, Kapur N, and O'Neill W. TCT CONNECT-176 Diastolic Suction Alarms Are an Early Marker for Right Ventricular Failure in the Setting of Left Ventricular Mechanical Circulatory Support. Journal of the American College of Cardiology 2020; 76(17):B76.
Journal of the American College of Cardiology
Background: Right ventricular failure (RVF) is associated with worse outcomes in patients with acute myocardial infarction and cardiogenic shock (AMICS). Diastolic suction alarms may be an early marker for RVF.
Methods: Patients enrolled in the National Cardiogenic Shock Initiative who underwent right heart catheterization demonstrating a central venous pressure (CVP) >12 mm Hg and in whom an Automated Impella Controller (AIC) log was available within the first 24 h of support were included. RVF was defined as a CVP >12 mm Hg with a pulmonary artery pulsatility index <1.
Results: A total of 100 patients were included in the analysis. Patients with RVF (n = 48) were compared to those without RVF (n = 52). Patients with RVF were more likely to have active CPR at the time of Impella placement (20.8% vs. 4.0%, p =< 0.01) and RCA involvement (54.2% vs. 27.3%, p < 0.01). Patients with RVF had lower MAP (46.4 vs. 54.6 mm Hg, p = 0.02) and higher lactate (7.1 vs. 4.5 mmol/l, p = 0.03) on admission. Patients with RVF had persistently higher lactate at 12 hours (5.6 vs. 3.4 mmol/l, p = 0.04). Patients with RVF had longer duration of diastolic suction (558 s vs. 210 s, p = 0.02), which was associated with higher in hospital mortality.
Conclusion: Diastolic suction alarms are an early marker of RVF in patients with elevated filling pressures being treated with left-sided Impella support. Increased duration of diastolic suction is associated with worse outcomes.