Trajectories of Cardiac Function Following Treatment With an Impella Device in Patients With Acute Anterior ST-Elevation Myocardial Infarction

Gregorio Tersalvi, Adrian Attinger-Toller, Dhanya Kalathil, Dario Winterton, Giacomo Maria Cioffi, Mehdi Madanchi, Thomas Seiler, Marc Stadelmann, Francesca Goffredo, Patrick Fankhauser, Federico Moccetti, Mathias Wolfrum, Stefan Toggweiler, Andreas Bloch, Richard Kobza, Florim Cuculi, Matthias Bossard, Gregorio Tersalvi, Adrian Attinger-Toller, Dhanya Kalathil, Dario Winterton, Giacomo Maria Cioffi, Mehdi Madanchi, Thomas Seiler, Marc Stadelmann, Francesca Goffredo, Patrick Fankhauser, Federico Moccetti, Mathias Wolfrum, Stefan Toggweiler, Andreas Bloch, Richard Kobza, Florim Cuculi, Matthias Bossard

Abstract

Background: Left ventricular (LV) unloading via the percutaneous micro-axial Impella pump is increasingly used in patients with anterior ST-segment elevation myocardial infarction (STEMI) and overt cardiogenic shock. In this context, the evolution of cardiac function and dimensions beyond hospital discharge remains uncertain. We aimed to characterize echocardiographic changes over time in patients with acute anterior STEMI treated with an Impella device.

Methods: From an ongoing prospective registry, consecutive patients with acute anterior STEMI managed with an Impella device were extracted. Transthoracic echocardiography was performed at index hospitalization and at first outpatient follow-up. Predictors of response, defined as a ≥ 10% absolute increase in left ventricular ejection fraction (LVEF) at follow-up, were sought.

Results: A total of 66 patients (89.4% male, aged 64.3 ± 11.6 years) with anterior STEMI were treated with an Impella device in the first 24 hours of hospitalization, from 2014 to 2022. In-hospital mortality was 24%. Major bleeding and vascular complications requiring surgery occurred in 24% and 11% of patients, respectively. At baseline, mean LVEF was 34% ±12%. At follow-up, survivors showed a significant increase in LVEF (P < 0.0001), whereas LV dimensions, diastolic parameters, and measures of right ventricular dimension and function remained stable. Overall, 28 patients had a ≥ 10% absolute increase in LVEF at follow-up. Baseline creatinine was the only significant predictor of response at univariate analysis.

Conclusions: Among patients with anterior STEMI requiring mechanical hemodynamic support with an Impella device, the majority of survivors showed a sustained increase in LV function, without evidence of adverse remodelling. This signal warrants further investigation in dedicated trials.

© 2022 The Authors.

Figures

Graphical abstract
Graphical abstract
Figure 1
Figure 1
Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) study flowchart. MCS, mechanical circulatory support; STEMI, ST-elevation myocardial infarction.
Figure 2
Figure 2
Trajectory of left ventricular ejection fraction (LVEF) from baseline (median: 0.95 days [range: 0.4-4.5] after admission) to first follow-up (median: 109.5 days [range: 76.8-163.45] after device implantation). Green indicates patients with a ≥ 10% absolute increase of LVEF at follow-up. Red indicates patients without a ≥ 10% absolute increase of LVEF at follow-up.

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