The Impella Microaxial Flow Catheter Is Safe and Effective for Treatment of Myocarditis Complicated by Cardiogenic Shock: An Analysis From the Global cVAD Registry

BACKGROUND: Myocarditis complicated by cardiogenic shock remains a complex problem. The use of acute mechanical circulatory support devices for cardiogenic shock is growing. We explored the utility of Impella transvalvular microaxial flow catheters in the setting of myocarditis with cardiogenic shock. METHODS AND RESULTS: We retrospectively analyzed data from 21 sites within the cVAD registry, an ongoing multicenter voluntary registry at sites in North America and Europe that have used Impella in patients with myocarditis. Myocarditis was defined by endomyocardial biopsy (n = 11) or by clinical history without angiographic evidence of coronary disease (n = 23). A total of 34 patients received an Impella 2.5, CP, 5.0, or RP device for cardiogenic shock complicating myocarditis. Baseline characteristics included age 42 ± 17 years, left ventricular ejection fraction (LVEF) 18% ± 10%, cardiac index 1.82 ± 0.46 L·min CONCLUSIONS: This is the largest analysis of Impella-supported myocarditis cases to date. The use of Impella appears to be safe and effective in the settings of myocarditis complicated by cardiogenic shock

Abstract 15943: Phenotypes of Cardiogenic Shock Associated With Increasing In-Hospital Mortality: A Report From The National Cardiogenic Shock Working Group Registry

Introduction: Cardiogenic shock (CS) mortality remains prohibitively high. A major limitation in the field has been the lack of large registries that include hemodynamic data for analysis. The National Cardiogenic Shock Working Group Registry is a multi-center retrospective database of CS patients in the United States. We now provide an interim update on the registry. Hypothesis: We hypothesized that escalating drug and device use are associated with increasing in-hospital mortality. Methods: We analyzed the Registry from 2017 to 2019. Modified versions of the SCAI Shock Classifications were employed. Class C and D shock patients were subdivided into two groups. Class C1 required up to one drug and no device therapy; C2 required one device without drug therapy; D1 required one drug and one device; D2 required greater than one drug and device therapy or multiple devices. Results: The Registry contains 1,565 CS patients due to any cause obtained from 8 medical centers. Hemodynamic data were available for 1079 patients. SCAI Class distribution was: \u3c1% A/B; 12% C1; 20% C2; 18% D1; 50% D2. Class E patients were excluded. Overall in-hospital mortality was 30.5% for the entire study and lower among patients with pulmonary artery catheter data available for analysis (28% vs 61%, p\u3c0.001; Odds Ratio 0.65 [0.5-0.84]). In-hospital mortality was associated with increasing SCAI Class and drug escalation (Figure). Compared to survivors, non-survivors had significantly increased right atrial pressure, pulmonary wedge pressure, lactate, and serum creatinine and decreased mean arterial pressure. Conclusions: Using the largest retrospective multicenter registry of CS with hemodynamic data, we report that a modified version of the SCAI CS Classification, escalating drug therapy, and increased congestion, but not cardiac output, correlate with increasing in-hospital mortality. These findings may inform the development of new management strategies and prognostic tools for CS

Vitamin D and cognitive function : A Mendelian randomisation study

The causal nature of the association between hypovitaminosis D and poor cognitive function in mid-to later-life is uncertain. Using a Mendelian randomisation(MR) approach, we examined the causal relationship between 25(OH)D and cognitive function. Data came from 172,349 participants from 17 cohorts. DHCR7(rs12785878), CYP2R1 rs12794714) and their combined synthesis score were chosen to proxy 25(OH)D. Cognitive tests were standardised into global and memory scores. Analyses were stratified by 25(OH)D tertiles, sex and age. Random effects meta-analyses assessed associations between 25(OH)D and cognitive function. Associations of serum 25(OH)D with global and memoryrelated cognitive function were non-linear (lower cognitive scores for both low and high 25(OH)D, p(curvature)Peer reviewe