Acute Effects of Impella 5.5 on Biventricular Filling and Pressure–Volume Area in Patients With Heart Failure Associated Cardiogenic Shock

Abstract

Use of Impella 5.5 in patients with decompensated heart failure-associated cardiogenic shock (ADHF-CS) is increasing as a bridge to advanced therapies. The effects of maximal trans-valvular unloading on biventricular filling and pressure–volume area (PVA) in ADHF-CS are poorly understood. Nine patients with medically refractory ADHF-CS underwent Impella 5.5 placement with simultaneous invasive arterial, venous, and biventricular pressure–volume loop analysis. Acutely after Impella 5.5 activation, cardiac output (3.4 ± 0.5 vs. 5.0 ± 0.7 L/min, p = 0.0011), diastolic (67.2 ± 8.0 vs. 80.7 ± 9.7 mm Hg, p = 0.0044) and mean arterial pressures (77.9 ± 7.1 vs. 86.9 ± 10.4 mm Hg, p = 0.029) increased, compared to baseline. Left ventricular end-diastolic pressure (24.1 ± 6.7 vs . 16.8 ± 5.4 mm Hg, p = 0.0027), volume (262.1 ± 103.9 vs. 231.5 ± 104.3 ml, p = 0.0036), and PVA (21,913 ± 7,055 vs . 18,357 ± 7,758 mmHg·ml, p = 0.013) decreased. Right ventricular end-diastolic (12.4 ± 4.6 vs . 9.1 ± 3.8 mm Hg, p = 3.8E‐5) and end-systolic pressure (42.1 ± 11.9 vs . 34.4 ± 11.1 mm Hg, p = 0.030) and PVA (6,303 ± 3,851 vs. 4,437 ± 2,473 mm Hg·ml, p = 0.027) also decreased. These findings suggest that maximal left ventricular unloading can acutely reduce biventricular filling pressures and PVA in patients with ADHF-CS.