nach oben

Erschienen in:

01.08.2015 | Original Paper

Intraaortic balloon counterpulsation and microcirculation in cardiogenic shock complicating myocardial infarction: an IABP-SHOCK II substudy

verfasst von: Christian Jung, Georg Fuernau, Suzanne de Waha, Ingo Eitel, Steffen Desch, Gerhard Schuler, Hans R. Figulla, Holger Thiele

Erschienen in: Clinical Research in Cardiology | Ausgabe 8/2015

Einloggen, um Zugang zu erhalten

Abstract

Objectives

This study sought to evaluate the influence of intraaortic balloon pump (IABP) counterpulsation on the microcirculation in patients with cardiogenic shock (CS) complicating acute myocardial infarction.

Background

In patients with shock profound alterations of the microcirculation have been observed and their clinical relevance has been described. Different treatment strategies exist to improve microvascular perfusion in patients with CS; however, the role of IABP treatment is not clearly defined.

Methods

A predefined substudy of the randomized Intraaortic Balloon Pump in Cardiogenic Shock II trial (IABP-SHOCK II) investigated the sublingual microcirculation using a sidestream darkfield intravital microscope on days 1, 2 and 4 after the onset of shock. Perfused capillary (<20 µm, PCD) and vessel densities (<100 µm, PVD), total capillary (TCD) and vessel (TVD) densities were determined. In addition, the proportion of perfused vessels was assessed.

Results

Forty-one patients were included in this substudy (n = 24 with IABP support vs. n = 17 without IABP support). No significant differences between treatment with or without IABP regarding PCD, PVD, TCD, TVD and the proportion of perfused vessels were evident on all three timepoints (p = n.s. for all). Microvascular perfusion showed inverse correlation with subsequent serum lactate levels (−0.366; p = 0.02) without being significantly correlated with lactate levels at the timepoint of the microcirculatory investigation. In Kaplan–Meier analysis microcirculatory parameters showed significant discrimination of prediction for time to death (p < 0.05 for all).

Conclusions

In patients with CS, there is no effect of IABP treatment on microvascular perfusion. Parameters of the microcirculation might be helpful to identify high risk patients.

Aissaoui N, Puymirat E, Tabone X, Charbonnier B, Schiele F, Lefevre T, Durand E, Blanchard D, Simon T, Cambou JP, Danchin N (2012) Improved outcome of cardiogenic shock at the acute stage of myocardial infarction: a report from the USIK 1995, USIC 2000, and FAST-MI French nationwide registries. Eur Heart J 33:2535–2543. doi:10.1093/eurheartj/ehs264 PubMedCrossRef

O’Gara PT, Kushner FG, Ascheim DD, Casey DE, Jr, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX, Anderson JL, Jacobs AK, Halperin JL, Albert NM, Brindis RG, Creager MA, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Kushner FG, Ohman EM, Stevenson WG, Yancy CW, American College of Emergency P, Society for Cardiovascular A, Interventions (2013) 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 61:e78–e140. doi:10.1016/j.jacc.2012.11.019 PubMedCrossRef

Buijs EA, Verboom EM, Top AP, Andrinopoulou ER, Buysse CM, Ince C, Tibboel D (2014) Early microcirculatory impairment during therapeutic hypothermia is associated with poor outcome in post-cardiac arrest children: a prospective observational cohort study. Resuscitation 85:397–404. doi:10.1016/j.resuscitation.2013.10.024 PubMedCrossRef

Cheng JM, den Uil CA, Hoeks SE, van der Ent M, Jewbali LS, van Domburg RT, Serruys PW (2009) Percutaneous left ventricular assist devices vs. intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock: a meta-analysis of controlled trials. Eur Heart J 30:2102–2108. doi:10.1093/eurheartj/ehp292 PubMedCrossRef

De Backer D, Creteur J, Dubois M-J, Sakr Y, Vincent J-L (2004) Microvascular alterations in patients with acute severe heart failure and cardiogenic shock. Am Heart J 147:91–99PubMedCrossRef

De Backer D, Hollenberg S, Boerma C, Goedhart P, Buchele G, Ospina-Tascon G, Dobbe I, Ince C (2007) How to evaluate the microcirculation: report of a round table conference. Crit Care 11:R101PubMedCentralPubMedCrossRef

De Backer D, Ospina-Tascon G, Salgado D, Favory R, Creteur J, Vincent JL (2010) Monitoring the microcirculation in the critically ill patient: current methods and future approaches. Intensive Care Med 36:1813–1825. doi:10.1007/s00134-010-2005-3 PubMedCrossRef

den Uil CA, Lagrand WK, Spronk PE, van der Ent M, Jewbali LS, Brugts JJ, Ince C, Simoons ML (2009) Low-dose nitroglycerin improves microcirculation in hospitalized patients with acute heart failure. Eur J Heart Fail 11:386–390CrossRef

den Uil CA, Lagrand WK, van der Ent M, Jewbali LS, Brugts JJ, Spronk PE, Simoons ML (2009) The effects of intra-aortic balloon pump support on macrocirculation and tissue microcirculation in patients with cardiogenic shock. Cardiology 114:42–46CrossRef

10.

den Uil CA, Lagrand WK, van der Ent M, Jewbali LS, Cheng JM, Spronk PE, Simoons ML (2010) Impaired microcirculation predicts poor outcome of patients with acute myocardial infarction complicated by cardiogenic shock. Eur Heart J 31:3032–3039. doi:10.1093/eurheartj/ehq324 CrossRef

11.

Donati A, Domizi R, Damiani E, Adrario E, Pelaia P, Ince C (2013) From macrohemodynamic to the microcirculation. Crit Care Res Pract 2013:892710. doi:10.1155/2013/892710 PubMedCentralPubMed

12.

Fengler K, Fuernau G, Desch S, Eitel I, Neumann FJ, Olbrich HG, de Waha A, de Waha S, Richardt G, Hennersdorf M, Empen K, Hambrecht R, Fuhrmann J, Bohm M, Poess J, Strasser R, Schneider S, Schuler G, Werdan K, Zeymer U, Thiele H (2015) Gender differences in patients with cardiogenic shock complicating myocardial infarction: a substudy of the IABP-SHOCK II-trial. Clin Res Cardiol 104:71–78. doi:10.1007/s00392-014-0767-2 PubMedCrossRef

13.

Hasdai D, Holmes DR Jr, Califf RM, Thompson TD, Hochman JS, Pfisterer M, Topol EJ (1999) Cardiogenic shock complicating acute myocardial infarction: predictors of death. GUSTO Investigators. Global utilization of streptokinase and tissue-plasminogen activator for occluded coronary arteries. Am Heart J 138:21–31PubMedCrossRef

14.

Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, Buller CE, Jacobs AK, Slater JN, Col J, McKinlay SM, LeJemtel TH (1999) Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should we emergently revascularize occluded coronaries for cardiogenic shock. N Engl J Med 341:625–634PubMedCrossRef

15.

Jung C, Ferrari M, Gradinger R, Fritzenwanger M, Pfeifer R, Schlosser M, Poerner TC, Brehm BR, Figulla HR (2008) Evaluation of the microcirculation during extracorporeal membrane-oxygenation. Clin Hemorheol Microcirc 40:311–314PubMed

16.

Jung C, Ferrari M, Rodiger C, Fritzenwanger M, Figulla HR (2008) Combined Impella and intra-aortic balloon pump support to improve macro- and microcirculation: a clinical case. Clin Res Cardiol 97:849–850PubMedCrossRef

17.

Jung C, Ferrari M, Roediger C, Fritzenwanger M, Goebel B, Lauten A, Pfeifer R, Figulla HR (2009) Evaluation of the sublingual microcirculation in cardiogenic shock. Clin Hemorheol Microcirc 42:141–148PubMed

18.

Jung C, Fuernau G, Muench P, Desch S, Eitel I, Schuler G, Adams V, Figulla HR, Thiele H (2015) Impairment of the endothelial glycocalyx in cardiogenic shock and its prognostic relevance. Shock. doi:10.1097/SHK.0000000000000329

19.

Jung C, Lauten A, Ferrari M (2010) Microcirculation in cardiogenic shock: from scientific bystander to therapy target. Crit Care 14:193PubMedCentralPubMedCrossRef

20.

Jung C, Lauten A, Rodiger C, Krizanic F, Figulla HR, Ferrari M (2009) Effect of intra-aortic balloon pump support on microcirculation during high-risk percutaneous intervention. Perfusion 24:417–421. doi:10.1177/0267659109358208 PubMedCrossRef

21.

Jung C, Rodiger C, Fritzenwanger M, Schumm J, Lauten A, Figulla HR, Ferrari M (2009) Acute microflow changes after stop and restart of intra-aortic balloon pump in cardiogenic shock. Clin Res Cardiol 98:469–475PubMedCrossRef

22.

Kaluski E, Milo-Cotter O, Cotter G (2009) ‘Death and life are in the power of the tongue’? Cardiology 114:39–41. doi:10.1159/000212059 PubMedCrossRef

23.

Kar B, Gregoric ID, Basra SS, Idelchik GM, Loyalka P (2011) The percutaneous ventricular assist device in severe refractory cardiogenic shock. J Am Coll Cardiol 57:688–696. doi:10.1016/j.jacc.2010.08.613 PubMedCrossRef

24.

Klijn E, Den Uil CA, Bakker J, Ince C (2008) The heterogeneity of the microcirculation in critical illness. Clin Chest Med 29:643–654. doi:10.1016/j.ccm.2008.06.008 PubMedCrossRef

25.

Koopmans M, Kuiper MA, Endeman H, Veenstra G, Vellinga NA, de Vos R, Boerma EC (2014) Microcirculatory perfusion and vascular reactivity are altered in post cardiac arrest patients, irrespective of target temperature management to 33 degrees C vs 36 degrees C. Resuscitation 86C:14–18. doi:10.1016/j.resuscitation.2014.09.025

26.

Lauten A, Engstrom AE, Jung C, Empen K, Erne P, Cook S, Windecker S, Bergmann MW, Klingenberg R, Luscher TF, Haude M, Rulands D, Butter C, Ullman B, Hellgren L, Modena MG, Pedrazzini G, Henriques JP, Figulla HR, Ferrari M (2013) Percutaneous left-ventricular support with the Impella-2.5-assist device in acute cardiogenic shock: results of the Impella-EUROSHOCK-registry. Circ Heart Fail 6:23–30. doi:10.1161/CIRCHEARTFAILURE.112.967224 PubMedCrossRef

27.

Munsterman LD, Elbers PW, Ozdemir A, van Dongen EP, van Iterson M, Ince C (2010) Withdrawing intra-aortic balloon pump support paradoxically improves microvascular flow. Crit Care 14:R161. doi:10.1186/cc9242 PubMedCentralPubMedCrossRef

28.

Prondzinsky R, Unverzagt S, Russ M, Lemm H, Swyter M, Wegener N, Buerke U, Raaz U, Ebelt H, Schlitt A, Heinroth K, Haerting J, Werdan K, Buerke M (2012) Hemodynamic effects of intra-aortic balloon counterpulsation in patients with acute myocardial infarction complicated by cardiogenic shock: the prospective, randomized IABP shock trial. Shock 37:378–384. doi:10.1097/SHK.0b013e31824a67af PubMedCrossRef

29.

Quitter F, Figulla HR, Ferrari M, Pernow J, Jung C (2013) Increased arginase levels in heart failure represent a therapeutic target to rescue microvascular perfusion. Clin Hemorheol Microcirc 54:75–85. doi:10.3233/CH-2012-1617 PubMed

30.

Scheidt S, Wilner G, Mueller H, Summers D, Lesch M, Wolff G, Krakauer J, Rubenfire M, Fleming P, Noon G, Oldham N, Killip T, Kantrowitz A (1973) Intra-aortic balloon counterpulsation in cardiogenic shock. Report of a co-operative clinical trial. N Engl J Med 288:979–984. doi:10.1056/NEJM197305102881901 PubMedCrossRef

31.

Sjauw KD, Engstrom AE, Vis MM, van der Schaaf RJ, Baan J Jr, Koch KT, de Winter RJ, Piek JJ, Tijssen JG, Henriques JP (2009) A systematic review and meta-analysis of intra-aortic balloon pump therapy in ST-elevation myocardial infarction: should we change the guidelines? Eur Heart J 30:459–468PubMedCrossRef

32.

Thiele H, Allam B, Chatellier G, Schuler G, Lafont A (2010) Shock in acute myocardial infarction: the Cape Horn for trials? Eur Heart J 31:1828–1835PubMedCrossRef

33.

Thiele H, Schuler G, Neumann FJ, Hausleiter J, Olbrich HG, Schwarz B, Hennersdorf M, Empen K, Fuernau G, Desch S, de Waha S, Eitel I, Hambrecht R, Bohm M, Kurowski V, Lauer B, Minden HH, Figulla HR, Braun-Dullaeus RC, Strasser RH, Rochor K, Maier SK, Mollmann H, Schneider S, Ebelt H, Werdan K, Zeymer U (2012) Intraaortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock: design and rationale of the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial. Am Heart J 163:938–945. doi:10.1016/j.ahj.2012.03.012 PubMedCrossRef

34.

Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, de Waha A, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Lauer B, Bohm M, Ebelt H, Schneider S, Werdan K, Schuler G, Intraaortic Balloon Pump in cardiogenic shock IIti (2013) Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet 382:1638–1645. doi:10.1016/S0140-6736(13)61783-3 PubMedCrossRef

35.

Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Fuhrmann J, Bohm M, Ebelt H, Schneider S, Schuler G, Werdan K, Investigators I-SIT (2012) Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 367:1287–1296. doi:10.1056/NEJMoa1208410 PubMedCrossRef

36.

Trzeciak S, McCoy JV, Phillip Dellinger R, Arnold RC, Rizzuto M, Abate NL, Shapiro NI, Parrillo JE, Hollenberg SM, Microcirculatory Alterations in R, Shock i (2008) Early increases in microcirculatory perfusion during protocol-directed resuscitation are associated with reduced multi-organ failure at 24 h in patients with sepsis. Intensive Care Med 34:2210–2217. doi:10.1007/s00134-008-1193-6 PubMedCentralPubMedCrossRef

37.

Zeymer U, Hochadel M, Hauptmann KE, Wiegand K, Schuhmacher B, Brachmann J, Gitt A, Zahn R (2013) Intra-aortic balloon pump in patients with acute myocardial infarction complicated by cardiogenic shock: results of the ALKK-PCI registry. Clin Res Cardiol 102:223–227. doi:10.1007/s00392-012-0523-4 PubMedCrossRef

Titel: Intraaortic balloon counterpulsation and microcirculation in cardiogenic shock complicating myocardial infarction: an IABP-SHOCK II substudy
verfasst von: Christian Jung
Georg Fuernau
Suzanne de Waha
Ingo Eitel
Steffen Desch
Gerhard Schuler
Hans R. Figulla
Holger Thiele
Publikationsdatum: 01.08.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: Clinical Research in Cardiology / Ausgabe 8/2015
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-015-0833-4

Neu im Fachgebiet Kardiologie

19.04.2024 | Vorhofflimmern | Nachrichten

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Intraaortic balloon counterpulsation and microcirculation in cardiogenic shock complicating myocardial infarction: an IABP-SHOCK II substudy

Abstract

Objectives

Background

Methods

Results

Conclusions

Neu im Fachgebiet Kardiologie

Parodontalbehandlung verbessert Prognose bei Katheterablation

Antihypertensiva schützen auch alte Menschen noch vor Demenz

Sind Betablocker auch für ältere herzschwache Personen nützlich?

Stillende Frauen haben geringeres kardiovaskuläres Risiko

Update Kardiologie

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Objectives

Background

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 8/2015

Renal impairment and worsening of renal function in acute heart failure: can new therapies help? The potential role of serelaxin

An integrative approach to slow pathway modulation in AVNRT using a novel ultra high-density electroanatomical mapping system

Extracellular remodeling in patients with wild-type amyloidosis consuming epigallocatechin-3-gallate: preliminary results of T1 mapping by cardiac magnetic resonance imaging in a small single center study

Incidence, prevalence and 1-year all-cause mortality of heart failure in Germany: a study based on electronic healthcare data of more than six million persons

Effects of renal sympathetic denervation on urinary sodium excretion in patients with resistant hypertension

Acute coronary syndrome in young women under 55 years of age: clinical characteristics, treatment, and outcomes

Neu im Fachgebiet Kardiologie

Parodontalbehandlung verbessert Prognose bei Katheterablation

Antihypertensiva schützen auch alte Menschen noch vor Demenz

Sind Betablocker auch für ältere herzschwache Personen nützlich?

Stillende Frauen haben geringeres kardiovaskuläres Risiko

Update Kardiologie