Author + information
- Shiva Annamalai1,
- Michele Esposito1,
- Sudeep Kuchibhotla1,
- Shelley Hall2,
- Theodore Schreiber3,
- William O'Neill4 and
- Navin Kapur1
Myocarditis complicated by cardiogenic shock (Myo-CS) remains a complex clinical problem. The use of acute circulatory support devices for CS is growing. We explored the clinical utility of Impella micro-axial flow catheters in the setting of Myo-CS.
We retrospectively analyzed data from 21 sites within the cVAD registry, an ongoing multicenter voluntary registry at sites in North America and Europe that have used Impella in patients with Myo-CS. Myocarditis was defined by endomyocardial biopsy in 34% (n=11) or by clinical history without angiographic evidence of coronary disease (n=23).
A total of 34 patients receiving Impella support for Myo-CS were identified. Mean age was 42±17 years with 17 males and mean left ventricular ejection fraction (LVEF) on admission was 18±10%. Baseline mean cardiac index was 1.8±0.5 L/min/m2, pulmonary capillary wedge pressure was 25±7 mmHg, and right atrial pressure was 22±3 mmHg. Mean lactate was 27±31 mg/dL. 32% (n=11) of patients required intra-aortic balloon pump and 85% (n=29) required pressor/inotrope therapy prior to Impella placement. Impella support was used for a mean duration of 90.56±74.26 hours. Mean LVEF improved from admission to discharge (18+10% to 37+20%, p=0.001). In-hospital mortality was 38% (n=13), 47% (n=16) of patients were discharged alive with 94% recovering without need for further device therapy (Figure).
This is the largest analysis of Impella-supported myocarditis cases to date. The use of the Impella appears to be safe and effective in the setting of Myo-CS.
CORONARY: Hemodynamic Support and Cardiogenic Shock