Association between lowering heart rate during IMPELLA support and favorable short-term outcome in patients with cardiogenic shock

Background

Impella has been increasingly used in patients with cardiogenic shock (CGS). Target values for clinical indices for appropriate management of Impella have not yet been established.

Purpose

We aimed to elucidate the association between heat rate (HR) during Impella treatment in patients with CGS and clinical outcomes.

Methods and results

We retrospectively evaluated 62 patients (68±14 years; male 77%) with CGS receiving temporary circulatory support with the Impella between February 1, 2019, and February 31, 2021. The primary end point was 30-day mortality. Clinical characteristics, laboratory and hemodynamic markers at implantation of Impella (baseline), 12, 24 hr after implantation, and removal of Impella were assessed. There were 28 patients with concomitant use of extracorporeal membrane oxygenation (ECMO). Treatment periods using Impella were 8±6 days. After excluding 11 patients who died during Impella support, the relationship between clinical indicators at each time points and 30-day mortality was evaluated. There were 22 patients (43%) with 30-day mortality. Factors associated with 30-day mortality were: female, ECMO, higher 24-hr lactate level, lower 24-hr cardiac power output, and higher HR at removal. Lower HR of ≤81 bpm at removal was found to most accurately predict lower 30-day mortality (Figure 1). Higher increases in dose of beta-blockers during Impella support and lower absolute doses of norepinephrine at removal were correlated with decreases in HR during Impella support.

Conclusions

In patients with CGS treated with Impella, lower HR at removal was associated with lower incidence of 30-day mortality. Lowering HR during Impella treatment was recognized as a simple indicator for favorable clinical outcomes in patients with CGS. It was suggested that chronotropic interventions during Impella treatment may be novel therapeutic options in patients with CGS.

Funding Acknowledgement

Type of funding sources: None. Figure 1

Clinical evaluation of 117 patients with Sjögren's syndrome

The clinical entity of Sjögren's syndrome was limited to exocrine gland involvements in the present study, and 117 patients fulfilling this criterium were evaluated clinically to clarify the features of this syndrome. The following conclusions were obtained. (1) Frequent overlapping of this syndrome with other autoimmune diseases was observed, (2) This syndrome was demonstrated in young patients and middle-aged as well as postmenopausal patients. (3) Some of systemic manifestations demonstrated in patients with associated diseases were also observed in many patients without definite associated diseases. (4) Various hematological and serological abnormalities were demonstrated even in patients without associated diseases, and therefore, the participation of either a chronic inflammatory or immunologic process was suggested in this syndrome. (5) In patients with associated diseases, influence of the associated diseases was prominent in accordance with the patients' age, systemic manifestations and serological abnormalities. (6) The subclinical nature of sicca symptoms in young patients, as well as the delayed advancement of glandular involvement in this syndrome, were suggested. (7) Different entities were suggested in some patients with only lachrymal involvement.

T lymphoreceptopathy in systemic lupus erythematosus

Decreases in numbers and functions of SLE T lymphocytes as a form of lymphoreceptopathy were investigated using T lymphocytes and sera obtained from both SLE patients and healthy subjects with respect to the effects of suppressor T cells and Con A induced suppressor factor against antibody formation, changes in the membrane microviscosity and the ultrastructure of membrane associated particles (MAPs) of T lymphocytes. The lymphoreceptopathy of SLE T lymphocytes was induced by decreased microviscosity and abnormalities of distribution, size and density of MAPs on the T lymphocyte membrane which can be modulated by serum factors consisting mainly of IgG as T cell membrane binding antibody and partially of IgM as cytotoxic antibody.

Correlation between postsialographical changes of salivary isoamylase levels in serum and histopathological findings in sublingual glands in patients with Sjögren's syndrome

Salivary isoamylase values in sera were evaluated before and after sialography in 14 patients with Sjögren's syndrome (SS) and were compared with those in non-SS patients. Non-SS patients consisted of cases of systemic lupus erythematosus, rheumatoid arthritis and ulcerative colitis. In non-SS patients, salivary isoamylase 3 to 6 hours after injection of Conray-400 increased to 2.3 +/- 0.5 fold higher than that prior to the injection and returned to the previous values after 48 hours. On the basis of increases in salivary isoamylase after injection of Conray-400, SS could be divided into three groups: the high response group, the group showing the same values as in non-SS patients and the low response group. The high response group was further classified into two subgroups. Salivary isoamylase before injection in the high response group was higher in patients who showed mild mononuclear cell infiltration histopathologically in their sublingual glands and was lower in patients whose sublingual glands showed diffuse infiltration of mononuclear cells. Mononuclear cells had infiltrated severely in the sublingual glands of patients in the low response group, although they showed salivary isoamylase values before injection within the same ranges as in non-SS patients. These data suggest that both salivary isoamylase before injection and maximum salivary isoamylase increased significantly in cases of mild sialadenitis, the former value decreased with increasing infiltration of mononuclear cells into the sublingual glands, and both values were lower in cases of severe sialadenitis.