Invasive left ventricle pressure–volume analysis: overview and practical clinical implications

Bastos, Marcelo B; Burkhoff, Daniel; Malý, Jiří; Daemen, Joost; Uil, Corstiaan A. den; Ameloot, Koen; Lenzen, Mattie J.; Mahfoud, Felix; Zijlstra, Felix; Schreuder, Johannes Jacobus; Mieghem, Nicolas Van

doi:10.1093/eurheartj/ehz552

Cited by 155 publications

(122 citation statements)

References 45 publications

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“…b Corresponding pressure-volume loops showing left shift with reduction in systolic pressure, and increased stroke volume. Copied with permission from Bastos et al [8] and Schreuder et al [9] circulatory support showed that patients supported with a pVAD had lower in-hospital mortality compared with IABP, despite the observation that patients in this group had more comorbidities [17]. Patients with pVAD also had lower cardiac, vascular, and respiratory complications and their duration of hospital stay was shorter.…”

Section: High-risk Percutaneous Coronary Interventionmentioning

confidence: 99%

“…By inflating the balloon immediately after aortic valve closure, diastolic and mean arterial pressures rise and coronary perfusion improves. On the other hand, a vacuum effect-caused by rapid deflation of the balloon just before aortic valve opening-provides a reduction in left ventricle afterload and thereby passively augments cardiac output (CO) [8]. The hemodynamic effect will vary based on the clinical setting and the overall stroke volume.…”

Section: Hemodynamicsmentioning

confidence: 99%

“…The bedside effects on aortic pressure curves are generally characterized by a decrease in systolic blood pressure, an increase in diastolic blood pressure, and an increase in mean arterial pressure ( Fig. 1a) [8]. A reduction in pulmonary capillary wedge pressure (PCWP) and an increase in stroke volume can be measured with right heart catheterization or estimated with echocardiography [8].…”

Section: Hemodynamicsmentioning

confidence: 99%

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Mechanical Support in Early Cardiogenic Shock: What Is the Role of Intra-aortic Balloon Counterpulsation?

Kimman

Mieghem

Endeman

et al. 2020

Curr Heart Fail Rep

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Purpose of Review We aim to summarize recent insights and provide an up-to-date overview on the role of intra-aortic balloon pump (IABP) counterpulsation in cardiogenic shock (CS). Recent Findings In the largest randomized controlled trial (RCT) of patients with CS after acute myocardial infarction (AMICS), IABP did not lower mortality. However, recent data suggest a role for IABP in patients who have persistent ischemia after revascularization. Moreover, in the growing population of CS not caused by acute coronary syndrome (ACS), multiple retrospective studies and one small RCT report on significant hemodynamic improvement following (early) initiation of IABP support, which allowed bridging of most patients to recovery or definitive therapies like heart transplant or a left ventricular assist device (LVAD). Summary Routine use of IABP in patients with AMICS is not recommended, but many patients with CS either from ischemic or non-ischemic cause may benefit from IABP at least for hemodynamic improvement in the short term. There is a need for a larger RCT regarding the role of IABP in selected patients with ACS, as well as in patients with non-ACS CS.

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Section: High-risk Percutaneous Coronary Interventionmentioning

confidence: 99%

Section: Hemodynamicsmentioning

confidence: 99%

Section: Hemodynamicsmentioning

confidence: 99%

See 1 more Smart Citation

Mechanical Support in Early Cardiogenic Shock: What Is the Role of Intra-aortic Balloon Counterpulsation?

Kimman

Mieghem

Endeman

et al. 2020

Curr Heart Fail Rep

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“…The method of PV loop has been described previously [10]. In brief, the invasive hemodynamic assessments were conducted using a Millar pressure catheter (SPR-838; Millar Instruments, Houston, TX, USA) through the right carotid artery into the LV cavity.…”

Section: Pressure-volume (P-v) Loopmentioning

confidence: 99%

Dapagliflozin Protects Doxorubicin-induced Cardiotoxicity in Breast Cancer Patients With Diabetes via Suppressing ER Stress

Chang¹,

Lin²,

Ho³

et al. 2020

Preprint

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Background: Cancer patients with diabetes have an increasing risk of Dox-induced cardiotoxicity. Despite previous studies reporting benefits of dapagliflozin on the cardiovascular system, it remains unknown whether dapagliflozin has a cardioprotective effect in cancer patients with diabetes receiving Dox therapy. The purpose of this study was to investigate the potential of dapagliflozin for preventing doxorubicin (Dox)-induced cardiotoxicity.Methods: Using Taiwan National Health Insurance Database, the incidence of heart failure of cancer patients with or without diabetes was investigated. Streptozotocin (STZ)-induced diabetic rats were pretreated with oral dapagliflozin (10 mg/kg/day) for 6 weeks followed by Dox (5 mg/kg/week) for 4 weeks via intraperitoneal injection. Sequential echocardiography was applied to assess cardiac function. For in vitro analysis, cardiomyocytes cultured in high glucose (30 mM) were treated with dapagliflozin at 10 M and subsequently exposed to Dox at 1 M. Apoptosis and endoplasmic reticulum (ER) stress-related protein expression were measured by immunohistochemistry and Western blotting.Results: Among the studied patients, those with diabetes had a higher risk of major adverse cardiovascular events including the development of heart failure. In diabetic rats, dapagliflozin reduced cardiac fibrosis and significantly improved cardiac function. Dapagliflozin effectively inhibited Dox-induced apoptosis and reactive oxygen species in cardiomyocytes under high glucose. Mechanistically, we showed that dapagliflozin decreased the cardiac expression of Bax and cleaved caspase 3 but increased Bcl-2. Dapagliflozin also significantly reduced ER stress-associated proteins including GRP78, PERK, eIF-2, ATF-4, and CHOP. Conclusions: Our study revealed for the first time that dapagliflozin mitigated Dox-induced cardiomyocyte apoptosis in diabetes via inhibiting ER stress. These results indicate that dapagliflozin could be useful for preventing cardiotoxicity in diabetic cancer patients receiving Dox treatment.

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“…Extracorporeal membrane oxygenation (ECMO) is one of the most utilized mechanical circulatory support (MCS) modalities in patients with cardiogenic shock (1). Nonetheless, a major disadvantage of peripheral veno-arterial (V-A) ECMO is the risk of increased left-heart filling pressures, especially in patients with highly reduced ejection fractions (EFs) (2).…”

Section: Introductionmentioning

confidence: 99%

Case Report First-in-Man Method Description: Left Ventricular Unloading With iVAC2L During Veno-Arterial Extracorporeal Membrane Oxygenation: From Veno-Arterial Extracorporeal Membrane Oxygenation to ECMELLA to EC-iVAC®

Tschöpe

Alogna

Faragli

et al. 2020

Front. Cardiovasc. Med.

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Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is increasingly used in bi-ventricular failure with cardiogenic shock to maintain systemic perfusion. Nonetheless, it tends to increase left ventricular (LV) afterload and myocardial oxygen demand. In order to mitigate these negative effects on the myocardium, an Impella CP ® (3.5 L/min Cardiac Output) can be used in conjunction with V-A ECMO (ECMELLA approach). We implemented this strategy in a patient with severe acute myocarditis complicated by cardiogenic shock. Due to a hemolysis crisis, Impella CP ® had to be substituted with PulseCath iVAC2L ® , which applies pulsatile flow to unload the LV. A subsequent improvement in LV systolic function was noted, with increased LV ejection fraction (LVEF), LV end-diastolic diameter (LVEDD) reduction, and a reduction in plasma free hemoglobin. This case documents the efficacy of iVAC2L in replacing Impella CP as a LV vent during V-A ECMO, with less hemolysis.

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Invasive left ventricle pressure–volume analysis: overview and practical clinical implications

Cited by 155 publications

References 45 publications

Mechanical Support in Early Cardiogenic Shock: What Is the Role of Intra-aortic Balloon Counterpulsation?

Mechanical Support in Early Cardiogenic Shock: What Is the Role of Intra-aortic Balloon Counterpulsation?

Dapagliflozin Protects Doxorubicin-induced Cardiotoxicity in Breast Cancer Patients With Diabetes via Suppressing ER Stress

Case Report First-in-Man Method Description: Left Ventricular Unloading With iVAC2L During Veno-Arterial Extracorporeal Membrane Oxygenation: From Veno-Arterial Extracorporeal Membrane Oxygenation to ECMELLA to EC-iVAC®

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