None listed
Conditions
Brief summary
Cardiogenic shock (CS) is a clinical syndrome which is characterised by cellular and tissue hypoxia due to either inadequate oxygen delivery, increased oxygen demand, or a combination of these processes. It may present on a clinical spectrum ranging from occult hypoperfusion (with preserved blood pressure) to fulminant circulatory collapse. For patients presenting with CS, approximately 80% of cases can be attributed to an underlying cause of acute coronary syndrome (ACS). In patients with refractory CS that is not responsive to conventional measures such as fluid resuscitation, inotropic or vasopressor supports and revascularisation, mechanical circulatory support (MCS) can represent a reasonable salvage therapy. To date there is no data assessing the impact of various support modalitites on coronary physiology. We aim to characterise coronary perfusion in the shocked state, comparing and contrasting the impact of various support strategies.
Interventions
It is our aim to characterise coronary and microcirculatory physiology in cardiogenic shock of differing aetiologies and in patients receiving various haemodynamic support strategies. Invasive coronary physiologic assessment will be performed using a 0.014-inch pressure/temperature-tipped angioplasty guidewire (PressureWire Certus or PressureWireX, manufactured by Abbott). This will be performed following routine coronary angiography (and percutaenous coronary intervention, if performed), while
It is our aim to characterise coronary and microcirculatory physiology in cardiogenic shock of differing aetiologies and in patients receiving various haemodynamic support strategies. Invasive coronary physiologic assessment will be performed using a 0.014-inch pressure/temperature-tipped angioplasty guidewire (PressureWire Certus or PressureWireX, manufactured by Abbott). This will be performed following routine coronary angiography (and percutaenous coronary intervention, if performed), while the patient is attending the catheterisation laboratory. Patients included will be those requiring haemodynamic support, which may include inotropes, VA ECMO, or Impella. Measurements will be perfomed whilst in the catheterisation laboratory (over a period of approximately 20 minutes) at baseline support and at 50% reduction in haemodynamic support (i.e VA ECMO flows reduced by 50%).
Sponsors
Alfred Health
Eligibility
Sex/Gender
Male
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Ages of 18 and above. 2. Coronary angiography being undertaken as part of routine patient care as determined by the treating team. 3. SCAI Shock stage C or less 4.Onset of symptoms <24 hours prior. 5.Measurements to be performed at time of coronary angiography
Exclusion criteria
• Pregnant and breastfeeding women, due to the radiation exposure inherent to this study • Non-cardiac cause of shock (e.g. pulmonary embolism, pneumothorax, cardiac tamponade, etc.) • Active bleeding • Prior coronary artery bypass grafting • Mechanical complication of surgery • Known left ventricular thrombus • Mechanical aortic valve • Patients with contraindications to adenosine including: asthma/bronchospasm, greater than first degree heart block or sick sinus syndrome without a pacemaker, symptomatic aortic stenosis or hypertrophic cardiomyopathy, cerebral ischaemia or current dipyridamole medication use. • Considered prohibitively hemodynamically unstable (e.g. Noradrenaline dose>50mcg/min) • Prolonged cardiac arrest (in or out-of-hospital) > 20 minutes prior to return of spontaneous circulation • Death is considered imminent
Outcome results
None listed