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Marta M, Zada M, Theuerkauf N, Duerr GD, Zimmer S, Treede H, Oezkur M. Outcome of right ventricular microaxial pump support in patients undergoing cardiac surgery. Sci Rep 2024; 14:8078. [PMID: 38580761 PMCID: PMC10997586 DOI: 10.1038/s41598-024-58602-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 04/01/2024] [Indexed: 04/07/2024] Open
Abstract
Right ventricular failure (RVF) after cardiac surgery is associated with an in-hospital mortality rate of up to 75%. Microaxial flow pumps are one of the mechanical circulatory supports (MCS) options available for the treatment of RVF, however the specifics of timing and indication for MCS, as well as predictors for survival, remain unclear due to a dearth of published data. We evaluated the clinical outcome of patients treated with Impella-RP for predictors of mortality and the hemodynamic effects of the pump. This is a single-center retrospective observational study involving adult patients who underwent cardiac surgery with cardiopulmonary bypass between January 2019 and December 2020 in cardiac surgery and required therapeutic management of RVF with an Impella-RP. Overall, 18 patients were included and analyzed for factors that could be associated with mortality, or that could be predictors of patient outcomes for this population. Treatment of RVF with Impella-RP improved the patient hemodynamics significantly and had a survival rate of 61% within 30 days. Patients with isolated CABG or better liver function before implantation had a better survival rate, which may indicate that underlying disease and timing of implantation are significant for successful treatment of RVF.
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Affiliation(s)
- Medina Marta
- Department of Cardiovasular Surgery, University Hospital of Mainz, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Mahmoud Zada
- Department of Cardiology and Rhythmology, Hospital Mechernich, Mechernich, Germany
| | - Nils Theuerkauf
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | - Georg Daniel Duerr
- Department of Cardiovasular Surgery, University Hospital of Mainz, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Sebastian Zimmer
- Department of Cardiology, University Hospital of Bonn, Bonn, Germany
| | - Hendrik Treede
- Department of Cardiovasular Surgery, University Hospital of Mainz, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Mehmet Oezkur
- Department of Cardiovasular Surgery, University Hospital of Mainz, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
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Geenty P, Sivapathan S, Stefani LD, Zada M, Boyd A, Kwok F, Thomas L. A novel echocardiographic risk score predicts prognosis in AL-amyloidosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Prognosis in light chain (AL) amyloidosis is largely determined by the severity of cardiac involvement. Conventional (Mayo) staging includes 1) hs troponin 2) N-terminal pro-beta natriuretic peptide (NT-pro BNP) and 3)free light chain difference.
Methods
In a retrospective study of 75 AL amyloidosis patients referred to a quaternary amyloid clinic, all patients underwent comprehensive echocardiographic assessment. Echocardiographic parameters included left ventricular (LV) ejection fraction, LV mass, diastolic function, global longitudinal strain (GLS) and indexed left atrial volume (LAVI). Mortality was assessed through review of clinical records.
Results
Over a median follow up of 51 months, 29/75 (39%) of patients died. LAVI, E/e', e', LVGLS, were univariate predictors of mortality (p<0.1). LAVI was the only independent echocardiographic predictor in a multivariable model. Kaplan Meir analysis evaluated LAVI, LVGLS and E/e' using clinical cutoffs as a predictor of survival; only LAVI and LVGLS were significant. A novel “Echo score” comprising of LAVI (>42 ml/m2) and LVGLS (<−12%) was a predictor of mortality with similar prognostic performance as Mayo stage. (Echo score AUC 0.745, 95% CI 0.64–0.85 vs Mayo score AUC 0.752 95% CI 0.66–0.86, p=0.9).
Conclusion
LAVI, a simple, echocardiographic parameter was as an independent predictor of mortality in AL amyloidosis. A composite echocardiographic score combining LAVI and LVGLS stratified AL-amyloidosis patients into 3 distinct groups with similar prognostic power as Mayo stage for all-cause mortality.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Geenty
- Westmead Hospital , Sydney , Australia
| | | | | | - M Zada
- Westmead Hospital , Sydney , Australia
| | - A Boyd
- Westmead Private Cardiology , Sydney , Australia
| | - F Kwok
- Westmead Hospital , Sydney , Australia
| | - L Thomas
- Westmead Hospital , Sydney , Australia
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Zada M, Lo Q, Trivedi S, Harapoz M, Boyd A, Devine K, Sadick N, Tchan M, Thomas L. Electrocardiographic Characteristics in Fabry Disease Patients: Impact of Impaired Longitudinal Strain and Left Ventricular Hypertrophy. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zada M, Geenty P, Lo Q, Boyd A, Devine K, Tchan M, Sadick N, Thomas L. 133 Left Ventricular Echocardiographic Structural Parameters That Determine Major Adverse Cardiovascular Events (MACE) in Fabry Disease. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ferkh A, Brown P, O'Keefe E, Zada M, Duggins A, Thiagalingam A, Altman M, Boyd A, Byth K, Kizana E, Denniss AR, Thomas L. Clinical and echocardiographic characteristics of cardioembolic stroke. Eur J Neurol 2019; 26:1310-1317. [PMID: 31062440 DOI: 10.1111/ene.13981] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 04/30/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Ischaemic stroke frequently has a cardioembolic (CE) source. Clinical and echocardiographic parameters associated with CE stroke were evaluated. METHODS In all, 93 consecutive ischaemic stroke patients who underwent a transthoracic echocardiogram were retrospectively analysed; strokes were classified by TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria. Echocardiographic parameters related to CE stroke, including left atrial volumes and function, were compared to 73 healthy controls. RESULTS Of 93 patients (mean age 66.1 years, 56% male), nine (10%) had large artery atherosclerosis, 38 (41%) CE stroke, two (2%) small vessel disease, two (2%) other and 42 (45%) undetermined aetiology. Left atrial (LA) maximum volumes (LAVImax ) and minimum volumes (LAVImin ) were larger in the CE group than the non-CE group (45 vs. 32 ml/m2 , 32 vs. 13 ml/m2 , respectively, P < 0.001), whilst LA function indices including LA emptying fraction and LA function index (LAFI) were lower in the CE group (34% vs. 55%, and 0.12 vs. 0.35, respectively, P < 0.001). Adjusting for clinical characteristics, LAFI ≤0.3 was an independent predictor of CE stroke (adjusted odds ratio 5.3, P = 0.001). Additionally, LAVImax and LAVImin were larger (61 vs. 44 and 32 vs. 24 ml/m2 respectively, P < 0.01) and LAFI significantly lower (0.34 vs. 0.52, P < 0.001) in the undetermined aetiology group versus healthy controls. CONCLUSIONS Left atrial enlargement with reduced LA function was associated with CE stroke and LAFI was the best independent predictor. LA parameters were also altered in the undetermined aetiology group, suggesting an underlying LA myopathy in this subset.
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Affiliation(s)
- A Ferkh
- University of Sydney, Camperdown, NSW, Australia.,Cardiology Department, Westmead Hospital, Sydney, NSW, Australia
| | - P Brown
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia
| | - E O'Keefe
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia
| | - M Zada
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia
| | - A Duggins
- Neurology Department, Westmead Hospital, Sydney, NSW, Australia
| | - A Thiagalingam
- University of Sydney, Camperdown, NSW, Australia.,Cardiology Department, Westmead Hospital, Sydney, NSW, Australia
| | - M Altman
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia
| | - A Boyd
- University of Sydney, Camperdown, NSW, Australia
| | - K Byth
- University of Sydney, Camperdown, NSW, Australia
| | - E Kizana
- University of Sydney, Camperdown, NSW, Australia.,Cardiology Department, Westmead Hospital, Sydney, NSW, Australia.,Westmead Institute of Medical Research, Sydney, NSW, Australia
| | - A R Denniss
- University of Sydney, Camperdown, NSW, Australia.,Cardiology Department, Westmead Hospital, Sydney, NSW, Australia
| | - L Thomas
- University of Sydney, Camperdown, NSW, Australia.,Cardiology Department, Westmead Hospital, Sydney, NSW, Australia.,South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
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