Multicenter registry of Impella-assisted high-risk percutaneous coronary interventions and cardiogenic shock in Poland (IMPELLA-PL)

BACKGROUND

Impella is a percutaneous mechanical circulatory support device for treatment of cardiogenic shock (CS) and high-risk percutaneous coronary interventions (HR-PCIs). IMPELLA-PL is a national retrospective registry of Impella-treated CS and HR-PCI patients in 20 Polish interventional cardiological centers, conducted from January 2014 until December 2021.

AIMS

We aimed to determine the efficacy and safety of Impella using real-world data from IMPELLA-PL and compare these with other registries.

METHODS

IMPELLA-PL data were analyzed to determine primary endpoints: in-hospital mortality and rates of mortality and major adverse cardiovascular and cerebrovascular events (MACCE) at 12 months post-discharge.

RESULTS

Of 308 patients, 18% had CS and 82% underwent HR-PCI. In-hospital mortality rates were 76.4% and 8.3% in the CS and HR-PCI groups, respectively. The 12-month mortality rates were 80.0% and 18.2%, and post-discharge MACCE rates were 9.1% and 22.5%, respectively. Any access site bleeding occurred in 30.9% of CS patients and 14.6% of HR-PCI patients, limb ischemia in 12.7% and 2.4%, and hemolysis in 10.9% and 1.6%, respectively.

CONCLUSIONS

Impella is safe and effective during HR-PCIs, in accordance with previous registry analyses. The risk profile and mortality in CS patients were higher than in other registries, and the potential benefits of Impella in CS require investigation.

[High-risk pulmonary embolism in early post-operative period]

High risk pulmonary embolism remains a major diagnostic and therapeutic challenge. One of the most difficult clinical situation is pulmonary embolism in patients in early postoperative period as most of them has contraindication to fibrinolysis. In this paper we present the case of patient with thrombophilia and pulmonary embolism diagnosed on the third day after cancer-related laparoscopic prostatectomy. Patient was successfully treated by means of percutaneous catheter thrombus defragmentation and intraarterial infusion of the reduced dose of alteplase.

[Angina pectoris due to coronary-subclavian steal syndrome caused by the LIMA graft in the patient after CABG with the use of the right and left mammary artery]

We present a case of a patient with unstable angina pectoris two years after coronary artery by-pass graft surgery with the use of the right and left mammary artery. The symptoms were caused by the critical RIMA stenosis and coronary-subclavian steal syndrome through the LIMA graft. Unsuccessful attempt of percutaneous angioplasty of the closed left subclavian artery was made. The angioplasty of the proximal part of the RIMA with the implantation of a drug eluting stent followed by the angioplasty of both left circumflex artery and obtuse marginal artery with the implantation of bare metal stents was performed. These procedures resulted in disappearance of anginal symptoms. Neurological examination did not reveal any signs of vertebrobasilar steal.

Giant post-infarction pseudoaneurysm of the left ventricle manifesting as severe heart failure

A 57 year-old female was admitted for chronic heart failure (HF) with NYHA class IV symptoms. Transthoracic echocardiography revealed ruptured left ventricular (LV) lateral and posterior wall between their basal and middle segments resulting in giant, round pseudoaneurysm formation with a diameter of 12 cm. Bidirectional flow through a 2.9 cm orifice between the LV and the pseudoaneurysm cavity was shown. A 12-cm diameter pseudoaneurysm was resected and the orifice was closed with a Dacron patch. Twelve months after the diagnosis, the patient is in a stable condition with NYHA class II HF symptoms.

[Recurrent cardiac tamponade and sepsis in a patient with rheumatoid arthritis]

Exudative pericarditis is found in 30-50% of the patients with rheumatoid arthritis (RA), particularly in later stages of the disease. Most cases present with no or few symptoms. We report a case of a 68 year-old male with a history of mild RA who developed exudative pericarditis leading to recurrent cardiac tamponade requiring repeated pericardiocenteses. Treatment with glucocorticosteroids, methotrexate and colchicine proved ineffective in preventing the recurrences. Immunosuppression contributed to the development of sepsis caused by Enterobacter cloacae and resulting in the patient's death.

[The case of surgically treated severe thromboemboic pulmonary hypertension developing in the course of recurrent pulmonary embolism]

A case of a patient with surgically treated progressive thromboembolic pulmonary hypertension in the course of recurrent pulmonary embolism resulting from deep vein thrombosis is presented. Acute embolic episode seems to have crucial role as an initiating factor triggering the cascade of unfavorable changes in pulmonary vasculature. The paper stresses the role of systematic clinical and echocardiographic control of patients after pulmonary embolism in order to diagnose developing complications as soon as possible. It would allow to introduce efficient treatment and improve prognosis.

Relationship between thoracic fluid content and natriuretic peptide type B in patients with systolic heart failure

BACKGROUND

Thoracic fluid content (TFC) is one of the basic parameters measured by impedance cardiography (ICG). The B-type natriuretic peptide (BNP) is a neuroendocrine mediator produced in the ventricular myocardium and released in response to the increase of wall tension.

AIM

To determine the relationship between TFC measured by ICG and BNP serum level in patients with systolic heart failure (HF).

METHODS

The study population included 50 patients: a group of 30 patients with systolic HF in functional NYHA class II and III [27 males and 3 females, aged 53 +/- 6 years, with mean left ventricular ejection fraction (LVEF) 23 +/- 6%], and 20 controls without HF symptoms and preserved LVEF. The TFC and BNP serum level were measured on the same day.

RESULTS

Mean BNP serum concentration was 521 +/- 882 pg/ml in HF patients and 44 +/- 36 pg/ml in healthy controls (p = 0.02). The TFC values did not differ significantly between the two groups (27.3 +/- 4.5 1/kW in the study group versus 26.3 +/- 2.8 1/kW in control subjects, NS). A significant correlation between TFC and BNP was found in patients with overt HF (r = 0.57, p = 0.001); however, after excluding one patient with exacerbation of HF symptoms, the correlation was non-significant (r = 0.24, p = 0.22). No correlation between these parameters was observed in healthy controls (r = 0.17, p = 0.51).

CONCLUSIONS

There was no significant correlation between TFC measured by ICG and BNP serum level in haemodynamically stable patients with HF symptoms. The usefulness of ICG measurements in patients with exacerbated chronic HF needs further investigations.

Immunoglobulin E as a marker of the atherothrombotic process in patients with acute myocardial infarction

BACKGROUND

Clot formation is a crucial moment in the patophysiology of acute coronary syndromes. The aim of this research was to assess the relationship between immunoglobulin E (IgE), lipid parameters and chosen hemostatic markers. The role of IgE as a possible participant in the atherothrombotic process was also investigated.

METHODS

A total of 80 patients with acute myocardial infarction (MI) was enrolled in the study. Concentrations of IgE, plasma lipid parameters, lipoprotein(a), markers of thrombin generation (TAT, AT III), markers of fibrinolysis (tPA:Ag, PAI-1:Ag, PAP, D-dimers) and markers of endothelial damage (von Willebrand factor) were measured in blood samples collected immediately after admission, before any treatment administration.

RESULTS

In patients with acute MI and with IgE concentration above 100 kU/l, IgE values were strongly, positively correlated with LDL concentration (p < 0.05), lipoprotein(a) concentration (p < 0.02) and negatively correlated with HDL plasma levels (p < 0.02). Exclusion of patients with IgE concentration lower than 150 kU/l strengthened the correlation between IgE concentration and LDL (p < 0.002) and lipoprotein(a) (p < 0.01) levels. It also revealed a significant correlation between IgE and TAT (p < 0.001), IgE and AT III (p < 0.002), and IgE and D-dimers (p < 0.05). IgE and TAT values measured 7, 14 and 40 days after infarction also showed significant positive correlation between increments of these parameters.

CONCLUSIONS

In patients with acute MI, a significant increase of thrombinogenesis and fibrinolysis markers is observed. Positive correlation between IgE concentration above 100 kU/l and markers of thrombinogenesis activation, lipid parameters and lipoprotein(a) levels, with significance increasing with IgE concentration and constant positive correlation between increments of IgE and TAT, can serve as evidence of IgE participation in the atherothrombotic process. (Cardiol J 2007; 14: 266-273).

[Diagnostic strategy and prognostic significance of syncope in patients with organic heart disease]

Chronic heart failure (CHF) is a very serious problem in the health care systems of all developed countries. Immense progress that has been made in medical sciences for the last twenty years, has not only caused remarkable lifespan prolongation, but has also resulted in increasing number of patients suffering from CHF. One of the most common chronic heart failure symptoms is syncope. Pathophysiologic background of this phenomenon is complicated and frequently connected with heart failure cause. It has been proved in a few studies that syncope in CHF patients is a unfavorable prognostic factor and can be a predictor of sudden cardiac death. Patients demonstrating syncope and suspected of organic heart disease should undergo echocardiographic examination, prolonged electrocardiographic monitoring and if necessary - electro-physiological study. Patients reporting chest pain suggestive of ischeamia before or after loss of consciousness should udergo an electrocardiographic stress test as a first evaluation step. The most probable mechanism of syncope in patients with structural heart disease is arrhythmia. It has been proven that patients with heart disease-related syncope have higher mortality rates than population without structural heart abnormalities. Higher incidence of sudden cardiac death in CHF patients experiencing syncope should not be forgotten by the physician. All causes of syncope should be carefully diagnosed, especially in this population. It may help to administer appropriate treatment and reduce sudden cardiac death risk.

[Polymorphic ventricular tachycardia of torsade de pointes type in patient with schizophrenia treated with thioridazine]

A case of 82 year-old female with schizophrenia treated with thioridazine with a long QT syndrome and polymorphic ventricular tachycardia of torsade de pointes type was presented. Additional predisposing factor for cardiac arrhythmia was diarrhea with subsequent hypokalemia. Infusion of magnesium sulphate, potassium supplementation and thioridazine discontinuation was effective management of the pathient.