TCT CONNECT-176 Diastolic Suction Alarms Are an Early Marker for Right Ventricular Failure in the Setting of Left Ventricular Mechanical Circulatory Support

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Conference Proceeding

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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.





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