Electrocardiogram-synchronized pulsatile extracorporeal life support preserves left ventricular function and coronary flow in a porcine model of cardiogenic shock

Abstract Funding Acknowledgements Type of funding sources: None. Background Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is an advanced technique in extracorporeal life support (ECLS) used to support extreme circulatory failure including patients with cardiac arrest and cardiogenic shock refractory to conventional support. It is a long-standing belief that peripheral V-A ECMO poses increased afterload to the inured heart, but conventional echocardiographic measurements are often insensitive in detecting subtle changes in loading conditions. Purpose This study aimed to evaluate the effects of varying blood flow during peripheral V-A ECMO on intrinsic myocardial contractility, using detailed echocardiographic assessment including speckle tracking echocardiography (STE). Methods Adult patients with acute cardiogenic shock who were supported by peripheral V-A ECMO from April 2019 to September 2020 were recruited. Serial hemodynamic and cardiac performance parameters were measured by transthoracic echocardiogram (TTE) within 48 hours after implementation of V-A ECMO, at different levels of extracorporeal blood flow – 100%, 120% and 50% of target blood flow (TBF). Results A total of 30 patients were included. 22 (71%) were male, and the mean (SD) age was 54 (13) years. The major indications for V-A ECMO were myocardial infarction (19, 63% patients), and myocarditis (5, 17%). With a decrease in extracorporeal blood flow from 100% to 50% of TBF, mean arterial pressure (MAP) dropped from 76+/-3 to 64+/-3mmHg (p <0.001), and cardiac index (CI) increased from 0.89+/-0.13 to 1.27+/-0.18L/min/m2 (p < 0.001). All indices of left ventricular contractility improved at a lower extracorporeal blood flow: the myocardial contractility measured by global longitudinal peak systolic strain (GLPSS) improved from -3+/-0.7% to -5+/-0.8% (p < 0.001); left ventricular ejection fraction (LVEF) increased from 21.5+/-2.6% to 30.9+/-2.7% (p < 0.001) and 19.7+/-3.1% to 28.4+/-3.2% (p < 0.001) by biplane and linear methods, respectively; left ventricular index of myocardial performance (LIMP) improved from 1.51+/-0.12 to 1.03+/-0.09 (p < 0.001). Similar findings were reproduced when comparing left ventricular contractility at extracorporeal blood flows of 120% and 50% of TBF. Conclusions The ECMO blood flow rate in peripheral V-A ECMO is inversely related to myocardial contractility, and is quantifiable by myocardial strain measured by STE.

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Effect of Glycoprotein IIb/IIIa Receptor Blockade on Recovery of Coronary Flow and Left Ventricular Function After the Placement of Coronary-Artery Stents in Acute Myocardial Infarction

Circulation ◽

10.1161/01.cir.98.24.2695 ◽

1998 ◽

Vol 98 (24) ◽

pp. 2695-2701 ◽

Cited By ~ 341

Author(s):

Franz-Josef Neumann ◽

Rudolf Blasini ◽

Claus Schmitt ◽

Eckhard Alt ◽

Josef Dirschinger ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Coronary Artery ◽

Left Ventricular Function ◽

Ventricular Function ◽

Coronary Flow ◽

Left Ventricular ◽

Receptor Blockade ◽

Coronary Artery Stents

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Hypoxia-induced activation of KATP channels limits energy depletion in the guinea pig heart

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1995.269.2.h734 ◽

1995 ◽

Vol 269 (2) ◽

pp. H734-H742 ◽

Cited By ~ 8

Author(s):

U. K. Decking ◽

T. Reffelmann ◽

J. Schrader ◽

H. Kammermeier

Keyword(s):

Guinea Pig ◽

Action Potential ◽

Left Ventricular Function ◽

Ventricular Function ◽

Coronary Flow ◽

Left Ventricular ◽

Monophasic Action Potential ◽

Resonance Spectroscopy ◽

Energy Status ◽

Guinea Pig Heart

The functional role of ATP-dependent potassium (KATP) in hypoxic cardiac failure was investigated in isolated guinea pig hearts with glibenclamide and rimalkalim as inhibitor and activator, respectively. Monophasic action potential duration at 90% of repolarization (MAP50), left ventricular function, and cardiac energy status (31P nuclear magnetic resonance spectroscopy) were measured during normotoxic (95% O2) and hypoxic (20% O2) perfusion. In normoxic hearts, 1 microM glibenclamide did not affect MAP50, left ventricular function, and coronary flow (n = 4). In contrast, rimalkalim rapidly shortened MAP50 and left ventricular pressure (LVP) in a dose-dependent fashion (e.g., by 60.2 +/- 3.5 and 80.8 +/- 8.2%, respectively, with 0.6 microM rimalkalim). This latter effect was reversed by 1 microM (glibenclamide (n = 4). With hypoxic perfusion, a reduction in LVP was observed, along with a shortening of the action potential (MAP90; 202 +/- 13 vs. 164 +/- 9 ms) and an increase in coronary flow. Glibenclamide (1 microM) reversed the MAP90 shortening and the increase in coronary flow. In addition, glibenclamide increased LVP transiently (n = 4). When coronary flow of hypoxic hearts was kept constant, however, glibenclamide elicited a sustained positive inotropic effect (n = 7). After glibenclamide, an increase in LVP from 54 +/- 4 to 64 +/- 3 mmHg was observed, along with a reduction in the free energy change of ATP hydrolysis from -54.5 +/- 1.9 to -52.9 +/- 0.2 nJ/mol and a further increase in the coronary venous adenosine from 269 +/- 48 to 1,680 +/- 670 nmol/l.(ABSTRACT TRUNCATED AT 250 WORDS)

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Effect of catheter-based transendocardial delivery of stromal cell-derived factor 1α on left ventricular function and perfusion in a porcine model of myocardial infarction

Basic Research in Cardiology ◽

10.1007/s00395-005-0570-3 ◽

2006 ◽

Vol 101 (1) ◽

pp. 69-77 ◽

Cited By ~ 24

Author(s):

Karl-Christian Koch ◽

Wolfgang M. Schaefer ◽

Elisa A. Liehn ◽

Christos Rammos ◽

Dominik Mueller ◽

...

Keyword(s):

Myocardial Infarction ◽

Left Ventricular Function ◽

Ventricular Function ◽

Stromal Cell ◽

Porcine Model ◽

Left Ventricular ◽

Stromal Cell Derived Factor

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Angiogenic potential of perivascularly delivered aFGF in a porcine model of chronic myocardial ischemia

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1998.274.3.h930 ◽

1998 ◽

Vol 274 (3) ◽

pp. H930-H936 ◽

Cited By ~ 4

Author(s):

John J. Lopez ◽

Elazer R. Edelman ◽

Alon Stamler ◽

Mark G. Hibberd ◽

Pottumarthi Prasad ◽

...

Keyword(s):

Growth Factors ◽

Myocardial Ischemia ◽

Left Ventricular Function ◽

Ventricular Function ◽

Coronary Flow ◽

Genetically Modified ◽

Left Ventricular ◽

Heparin Binding ◽

Regional Left Ventricular Function ◽

Chronic Myocardial Ischemia

A number of heparin-binding growth factors, including basic (bFGF) and acidic (aFGF) fibroblast growth factors have been shown to promote angiogenesis in vivo. In this study, we employed a sustained-release polymer extravascular delivery system to evaluate the angiogenic efficacy of a novel form of genetically modified aFGF in the setting of chronic myocardial ischemia. Fifteen Yorkshire pigs subjected to Ameroid occluder placement on the left circumflex (LCX) artery were treated with perivascularly administered aFGF in ethylene vinyl acetate (EVAc) polymer (10 μg, n = 7) or EVAc alone (controls, n = 8). Seven to nine weeks later, after coronary angiography to document Ameroid-induced coronary occlusion, all animals underwent studies of coronary flow and global and regional left ventricular function. Microsphere-determined coronary flow in the Ameroid-compromised territory was significantly increased in aFGF-treated compared with control animals, and this improvement in perfusion was maintained during ventricular pacing. Left ventricular function studies demonstrated improved global and regional function in aFGF-treated animals. We conclude that local perivascular delivery of genetically modified aFGF results in significant improvement in myocardial flow and regional and global left ventricular function.

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Inverted takotsubo syndrome complicated with cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation in a patient with bilateral pheochromocytoma: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa055 ◽

2020 ◽

Vol 4 (2) ◽

pp. 1-5

Author(s):

Bebiana Manuela Monteiro Faria ◽

João Português ◽

Roberto Roncon-Albuquerque Jr ◽

Rodrigo Pimentel

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Cardiogenic Shock ◽

Life Support ◽

Extracorporeal Life Support ◽

Left Ventricular ◽

Circulatory Support ◽

Lv Function ◽

Takotsubo Syndrome ◽

Membrane Oxygenation ◽

Lv Dysfunction

Abstract Background Takotsubo syndrome (TS) is characterized by a transient left ventricular (LV) dysfunction and rarely presents with cardiogenic shock (CS). Inverted TS (ITS) is a rare entity associated with the presence of a pheochromocytoma. Case summary We present a case of a young woman was admitted to the emergency department due to intense headache, chest discomfort, palpitations, and breathlessness. An ITS secondary to a pheochromocytoma crisis presenting with CS was diagnosed. The patient was managed with veno-arterial extracorporeal membrane oxygenation, until recovery of LV function. On the 35th day of hospitalization, open bilateral adrenalectomy was performed. Discussion Takotsubo syndrome patients presenting with CS are challenging and clinicians should be aware of underlying causes. Specific triggers such as pheochromocytoma should systematically be considered particularly if ITS was presented. Extracorporeal life support devices could provide temporary mechanical circulatory support in patients with TS on refractory CS and help to manage complex cases with TS due to pheochromocytoma.

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