Dataset Information

Intracoronary pyruvate in cardiogenic shock as an adjunctive therapy to catecholamines and intra-aortic balloon pump shows beneficial effects on hemodynamics.

ABSTRACT:

Aims

Pyruvate was shown to increase cardiac performance in isolated human and animal myocardium and in patients with chronic heart failure. We sought to investigate the effects of pyruvate in acute heart failure.

Methods and results

Patients presenting with cardiogenic shock because of acute myocardial infarction were subjected to standard care with primary PCI and intra-aortic balloon pump (IABP). Then, a Swan-Ganz catheter was placed in the pulmonary artery and hemodynamics was analyzed before, during and after intracoronary administration of 300 mmol/L pyruvate (360 ml/h). Pyruvate induced a significant increase in cardiac index (CI 2.23 ± 0.53 vs. 1.95 ± 0.45 L min(-1) m(-2); p < 0.05), stroke volume index (SVI, 29 ± 6 vs. 26 ± 5 mL m(-2); p < 0.05), and mean systemic arterial pressure (mean SAP, 95 ± 9 vs. 87 ± 9 mmHg; p < 0.05), whereas heart rate did not significantly change. The effects occurred rapidly within 30 min and were reversible within 10 min.

Conclusion

Intracoronary pyruvate might show beneficial effects in severe acute heart failure in addition to treatment with catecholamines and IABP. These effects should be further investigated in randomized controlled trials.

SUBMITTER: Schillinger W

PROVIDER: S-EPMC3079830 | biostudies-literature | 2011 May

REPOSITORIES: biostudies-literature

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Publications

Intracoronary pyruvate in cardiogenic shock as an adjunctive therapy to catecholamines and intra-aortic balloon pump shows beneficial effects on hemodynamics.

Schillinger Wolfgang W Hünlich Mark M Sossalla Samuel S Hermann Hans-Peter HP Hasenfuss Gerd G

Clinical research in cardiology : official journal of the German Cardiac Society 20101204 5

<h4>Aims</h4>Pyruvate was shown to increase cardiac performance in isolated human and animal myocardium and in patients with chronic heart failure. We sought to investigate the effects of pyruvate in acute heart failure.<h4>Methods and results</h4>Patients presenting with cardiogenic shock because of acute myocardial infarction were subjected to standard care with primary PCI and intra-aortic balloon pump (IABP). Then, a Swan-Ganz catheter was placed in the pulmonary artery and hemodynamics was ...[more]

PMID: 21132310

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Project description:Cardiogenic shock (CS) is the leading cause of death in patients hospitalized with acute myocardial infarction (AMI). Biomarkers might help in risk stratification and understanding of pathophysiology. Preliminary data suggests that patients with CS face a profound increase in the osteocyte-derived hormone fibroblast growth factor 23 (FGF-23), which acts as a negative regulator of serum phosphate levels. The present study aimed to assess the predictive role of FGF-23 for clinical outcome in a large cohort of CS patients with and without renal dysfunction.In the randomized Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial, 600 patients with CS complicating AMI were assigned to therapy with or without IABP. Our predefined biomarker substudy included 182 patients. Blood sampling was performed in a standardized procedure at three different time points (day 1 (day of admission), day 2 and day 3). Differences in outcome of patients with FGF-23 levels<and>median were compared by log-rank testing. Stepwise logistic regression modeling was performed to identify predictors of death at 30 days and Cox regression analysis for time to death during the first year.At all three time points, nonsurvivors had significantly higher FGF-23 levels compared to survivors (P<0.001 for all). Patients with FGF-23 levels above the median (395 RU/mL [interquartile range 102;2,395]) were characterized by an increased 30-day mortality and 1-year mortality. In multivariable analysis FGF-23 levels remained independent predictors for 30-day (odds ratio per 10log 1.80, 95% confidence interval (CI) 1.11 to 2.92; P=0.02) and 1-year mortality (hazard ratio 1.50, 95% CI 1.11 to 2.04, P=0.009). After stratifying the patients according to their baseline serum creatinine levels, the negative prognostic association of increased FGF-23 was only significant in those with serum creatinine greater than median.In CS, high levels of FGF-23 are independently related to a poor clinical outcome. However, this prognostic association appears only to apply in patients with impaired renal function.ClinicalTrials.gov NCT00491036. Registered 22 June 2007.

Dataset Information

Intracoronary pyruvate in cardiogenic shock as an adjunctive therapy to catecholamines and intra-aortic balloon pump shows beneficial effects on hemodynamics.

Aims

Methods and results

Conclusion

Publications

Intracoronary pyruvate in cardiogenic shock as an adjunctive therapy to catecholamines and intra-aortic balloon pump shows beneficial effects on hemodynamics.

Similar Datasets

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