Department of Cardiology Odense University Hospital Odense Denmark.
Faculty of Health Sciences University of Southern Denmark Odense Denmark.
J Am Heart Assoc. 2023 Feb 7;12(3):e8126. doi: 10.1161/JAHA.122.027831. Epub 2023 Feb 3.
Background The response of the left ventricle to cardiogenic shock (CS) caused by right ventricular (RV) infarction and the effect of treatment with either vasoactive treatment or Impella RP are not well described. We sought to determine RV and left ventricular longitudinal strain (LS) by echocardiography after initiation of either Impella RP or vasoactive treatment for CS induced by right coronary artery embolization. Methods and Results CS was induced with microsphere embolization in the right coronary artery in 20 pigs. Shock was defined as a reduction in cardiac output of ≥50% and/or an SvO <30%. At the time of CS either Impella RP or vasoactive treatment (norepinephrine and milrinone) was initiated. Echocardiography and conductance measures were obtained at baseline, when CS was present, and 30, 90, and 180 minutes after induction of CS. Of 20 animals, 14 completed the protocol and were treated with either vasoactive treatment (n=7) or Impella RP (n=7); 6 animals died (3 in each group). In the RV there was a significantly higher LS with the vasoactive treatment compared with Impella RP (-7.6% [4.5] to -6.0% [5.2] vs -4.5% [6.6] to -14.2% [10.6]; <0.006). Left ventricular LS improved with both treatments compared with shock, but with a larger effect (-9.4% [3.2] to -17.9% [3.6]) on LS with vasoactive treatment than Impella RP (-9.8% [3.1] to -12.3% [4.6]; <0.001). We found a significant correlation between stroke work and RV LS (r=-0.60, <0.001) and left ventricular LS (r=-0.62, <0.001). Conclusions We found significantly higher hemodynamic effects with vasoactive treatment compared with Impella RP in both the RV and left ventricular but at a cost of increased stroke work.
由右心室（RV）梗死引起的心源性休克（CS）对左心室的反应以及使用血管活性药物或 Impella RP 进行治疗的效果并未得到很好的描述。我们试图通过超声心动图确定在右冠状动脉栓塞引起的 CS 开始时使用 Impella RP 或血管活性药物治疗后的 RV 和左心室纵向应变（LS）。
在 20 只猪的右冠状动脉中用微球栓塞诱发 CS。当心脏输出量降低≥50%和/或 SvO <30%时定义为休克。在 CS 发生时，要么开始使用 Impella RP，要么开始使用血管活性药物（去甲肾上腺素和米力农）治疗。在基线、CS 发生时以及 CS 发生后 30、90 和 180 分钟时进行超声心动图和电导测量。在 20 只动物中，有 14 只完成了方案，并接受了血管活性药物（n=7）或 Impella RP（n=7）治疗；6 只动物死亡（每组 3 只）。与 Impella RP 相比，血管活性药物治疗的 RV LS 明显更高（-7.6%[4.5]至-6.0%[5.2]比-4.5%[6.6]至-14.2%[10.6]；<0.006）。与 CS 相比，两种治疗方法均使左心室 LS 得到改善，但血管活性药物治疗的 LS 改善幅度更大（-9.4%[3.2]至-17.9%[3.6]），而 Impella RP 的 LS 改善幅度较小（-9.8%[3.1]至-12.3%[4.6]；<0.001）。我们发现 RV LS 与 stroke work 之间存在显著相关性（r=-0.60，<0.001），左心室 LS 与 stroke work 之间也存在显著相关性（r=-0.62，<0.001）。
与 Impella RP 相比，我们发现血管活性药物治疗在 RV 和左心室均产生了更高的血流动力学效应，但代价是 stroke work 增加。
