Patient Identification
Early Identification of Right Heart Failure and Early Use of Impella RP® heart pump is Associated with Significantly Higher Survival Rate
The prospective, multi-center FDA PMA post-approval study compared survival in patients who would have met enrollment criteria for the RECOVER RIGHT trial to those who would not have qualified for the trial because they were in cardiogenic shock for more than 48 hours. The ongoing PMA post-approval study found patients who received Impella RP support within 48 hours of cardiogenic shock onset had a significantly higher survival rate than those who received delayed right-heart support (73% vs. 14%, p<0.001)1. The 73% survival rate is comparable to the pre-PMA RECOVER RIGHT and HDE studies survival rate.
Data presented at TCT Connect 2020, the 32nd annual scientific symposium of the Cardiovascular Research Foundation, finds early identification of right heart failure and early use of Impella RP is associated with significantly higher survival rates. Early identification of patients requiring right-heart support is critical because prior studies have shown 37% of AMI cardiogenic shock (AMICS) patients exhibit right heart dysfunctiona, which results in a three-times increased risk of mortality.2
How to Identify Right Ventricular Failure (RVF)
Cardiac index <2.2 L/min/m2 despite continuous high dose inotropes (as defined by the RECOVER RIGHT clinical trial), and any of the following1:
CVP >15 mmHg
- CVP/PCWP >0.63
Moderate to severe global right ventricular (RV) dysfunction on echo defined as one of the following1:
- Global RV hypokinesis
- TAPSE score of ≤14 mm
- RV diameter at base >42 mm
- RV short axis (or mid-cavity) diameter >35 mm
Importance of Identifying Right Ventricular Failure
- RVF can occur after acute myocardial infarction (AMI), after durable LVAD implantation, post-cardiotomy or post-transplant
- RVF increases the risk of cardiogenic shock, high-grade atrioventricular-conduction block and in-hospital mortality2
- RVF can lead to longer ICU stays, higher short-term mortality and worsening end-organ dysfunction
Criteria for Consideration of Right-Sided Support in AMI Cardiogenic Shock
- Hemodynamic Parameters
- CPO2 <0.6
- Lactate3 >4
- PAPI4 <1.0
- CI < 2.2 L/min/m2 (despite inotropic support)4
“Prolonged diastolic suction alarms can be an early marker of right ventricular failure in patients with elevated filling pressures.”
- BABAR BASIR, DO, CO-PRINCIPAL INVESTIGATOR OF NCSI STUDY
Dr. Tim Larkin about weaning protocol of the Impella RP heart pump
Dr. Tim Larkin describes weaning protocol for the Impella RP heart pump.
References
1. Anderson, M.B., et al. (2015). J Heart Lung Transplant, 34(12), 1549-1560.
2. Mehta, S.R., et al. (2001). J Am Coll Cardiol, 37(1), 37-43.
3. Fincke, R., et al. (2004). J Am Coll Cardiol, 44(2), 340-348.
4. Basir, Lactate and CPO reliably precict. TCT 2018.
5. Korabathina, (2012). SCAI, 80, 593-600.
6. Mehta, et al. (2018). J Am Coll Cardiol, 24, 148-156.
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