Hemodynamics and descriptive parameters from placebo- and PETN-treated CHF rats compared with sham-operated placebo-treated rats.

<p>CHF was defined by elevated left ventricular end-diastolic pressure (LVEDP, >15 mmHg) and impaired left ventricular function, values are means ± standard error (* = p<0.01 vs. Sham;^# = p<0.05 vs. CHF Placebo). MI = myocardial infarction; LV = left ventricle; RV = right ventricle; BW = body weight; LVSP = left-ventricular systolic pressure; LVEDP = left-ventricular end-diastolic pressure; MPV = mean platelet volume</p><p>Hemodynamics and descriptive parameters from placebo- and PETN-treated CHF rats compared with sham-operated placebo-treated rats.</p

Final aggregation of platelets from CHF rats ex vivo.

<p>Final ADP-induced aggregation was significantly enhanced in CHF-placebo vs. sham-operated animals at different ADP concentrations and normalized and partly even decreased following chronic PETN treatment, n = 10–12; <b>I-V</b> = different ADP concentrations in detail (1/2/5/10/20μM ADP).</p

Activation of circulating platelets in CHF.

<p>Platelet-bound fibrinogen is significantly increased in CHF-placebo (mean fluorescence intensity (MFI): Sham 88±4, CHF-placebo 104±6, p<0.05) and reduced following treatment with PETN (89±7, p<0.05 vs. CHF-placebo), n = 8–12.</p

Maximal aggregation of platelets from CHF rats ex vivo.

<p>Maximal ADP-induced aggregation was significantly enhanced in CHF-placebo vs. sham-operated animals at different ADP concentrations and normalized and partly even decreased following chronic PETN treatment, n = 10–12; <b>I-V</b> = different ADP concentrations in detail (1/2/5/10/20μM ADP).</p

Acquired von Willebrand syndrome in cardiogenic shock patients on mechanical circulatory microaxial pump support

<div><p>Early use of mechanical circulatory support, e.g. veno-arterial extracorporeal membrane oxygenation (ECMO) or left ventricular unloading by microaxial pump in refractory cardiogenic shock is recommended in current guidelines. Development of acquired von Willebrand Syndrome (AVWS) in patients with left ventricular assist devices (LVADs) and ECMO has been reported. There is an increasing number of patients treated with the Impella^® CP microaxial pump for left ventricular unloading. However, the prevalence of AVWS in these high risk patients is unknown and needs to be determined. We therefore screened 21 patients (68 ± 11years) treated with Impella^® (17 for cardiogenic shock, 4 for protected PCI) for the presence of AVWS by determining von Willebrand factor multimers, VWF collagen binding capacity and VWF antigen. During the time course of Impella^® support, 20/21 patients (95%) developed AVWS (mean duration of support: 135 ± 114 hours, mean time from device implantation to first diagnosis of AVWS: 10.6 ± 10.8 hours). Our data indicate that AVWS is a common phenomenon during left ventricular unloading via microaxial pump support. Thus, AVWS has to be considered as contributing factor for potential bleeding complications in this high risk patient population, especially in the context of dual antiplatelet therapy.</p></div

Patient characteristics.

<p>Patient characteristics.</p

Course of VWF:CB / VWF:Ag ratio.

<p>Significant reduction of VWF:CB / VWF:Ag ratio during Impella^® support—and normalization after cessation of left ventricular unloading. n = 12, *p<0.05 vs pre / post Impella^® therapy.</p

Diagnostics of von Willebrand syndrome.

<p>Diagnostics of von Willebrand syndrome.</p

Representative electrophoresis.

<p>Low-resolution gel (1.2%) of plasma from a patient with Impella^® support (marked lane) compared to other plasma samples. Very large VWF multimers are missing, large multimers are reduced.</p

Characteristic electrophoresis at different time points.

<p>Characteristic low-resolution gel (1.2%) of a patient with Impella^®: Very large multimers are absent and large multimes are reduced during microaxial pump support. Existence / recovery of large multimers is documented before and after mechanical left ventricular unloading. The right lane illustrates a characteristic trace of a plasma sample from a healthy person.</p