Prognostic Value of a 6-Minute Walk Test in Patients Undergoing Percutaneous Coronary Intervention: A Prospective Study

The 19th Annual Scientific Meeting evidence looking at optimal resuscitation strategies for patients with VAD and this isn’t addressed by the current resuscitation guidelines. However, the protocol at most institutions discourages use of ECC in patients with VAD. This deviation from conventional resuscitation algorithm is largely driven by the concern that chest compression could dislodge the VAD inflow cannula, especially early on after implantation. We present a case series of 4 patients at our institution that underwent chest compression during CPR. Hypothesis: ECC may be a safe and effective resuscitation tool in patients with VAD. A VAD that is functioning during cardiac arrest could potentially provide adequate cardiac output (C.O). However, if there is clinical evidence of circulatory collapse (mean arterial pressure below 40 mmHg) ECC may prove beneficial in restoring perfusion. We hypothesize using end tidal CO2, a surrogate for C.O, to direct initiation of ECC. An ETCO2 value of less than 20mmHg can be used to direct ECC in patients with VAD. A higher ETCO2 would suggest adequate perfusion pressure is maintained by VAD and may forgo need for ECC. Methods: This case series was performed at a single North American tertiary medical center. Clinical data was gathered by review of hospital chart and emergency medical services (EMS) documents. Autopsy data was used to verify integrity of VAD after ECC. Results: We present the data on four patients with left ventricular assist device (LVAD) who underwent CPR. Three out of these four patients received ECC. ROSC was established in two patients. All LVADs were heart mate II and were implanted at our institution. All four were destination therapy. One of the patients had a recent VAD exchange due to pump failure. Cause of arrest was cardiac in three patients and primary respiratory in one patient. Autopsy was performed in three of these four patients who had received ECC and the VAD circuit was intact in all including a fresh implant. The fourth patient who didn’t receive ECC had primary respiratory failure and didn’t require ECC based on ETCO2 value of higher than 20mmHg. This patient had successful resuscitation. Conclusions: Based on our experience with these four patients with LVAD, one of whom was a new implant, we suggest that ECC can be safely performed in this population. Chest compression may not be necessary in all VAD patients during cardio pulmonary Table 1.

Age Type of Patient (yrs) Gender LVAD 1

77

Male

HM II

2 3 4

56 80 80

Male Female Male

HM II HM II HM II

Cause of Days Heart on Cause Failure support of death



HFSA

S127

arrest and should be dictated by the measurement of ETCO2. More evidence is needed to consolidate these recommendations.

317 Prognostic Value of a 6-Minute Walk Test in Patients Undergoing Percutaneous Coronary Intervention: A Prospective Study Bhavin C. Patel, Siddharth A. Wayangankar, Udho Thadani, Pedro Lozano, Faisal Latif, Daniel Zhao, Cheuk Leung, Tarun W. Dasari; University of Oklahoma Health Sciences Center, Oklahoma City, OK Background: 6 Minute Walk Distance (6MWD) is a well-validated prognostic tool in heart failure. However its utility in post percutaneous coronary intervention (PCI) patients remains unknown. Methods: We conducted a prospective study (N5212) from July 2010-October 2011 wherein patients underwent a 6-minute walk test (N5176) within 2 weeks of PCI (for acute coronary syndrome (ACS), stable angina and abnormal non-invasive stress test). The primary endpoint was major adverse cardiac events (MACE)-death, ACS and HF admission, within one year post PCI. ROC curves were used to determine the predictability of 6MWD on MACE. Youden Index was applied on the ROC curve to measure the effectiveness of 6MWD to classify patients with MACE. Results: 98% of the subjects were male. Mean age was 64.96 8.8 yrs. and major co-morbidities were hypertension (88%), diabetes (45%) and dyslipidemia (88%). 176 (83%) patients had 6MWD and clinical follow up data available. In the overall population one year adverse event rates were: MACE (22%), ACS (18%), HF admission (4%), and death (3%). 6MWD had an AUC of 0.58, indicating that 6MWD may be a poor predictor of MACE. However the 6MWD was shorter for patients who had MACE (293 vs 326 meters, p50.038). Among patients with previous history of HF (N550): 8(21%) had MACE. 6MWD in this group had an AUC of 0.64. For the end-point of HF admission during the follow up, the AUC was 0.78, suggestive of good predictive power (Figure 1, panel A&B). Using this curve for HF admissions, a cut off of 335 m was derived. Patients who achieved ! 335m(6MWD) had a greater probability of having HF admission although this did not reach statistical significance (Odds ratio (0.44; 95% CI 0.037-5.38). Conclusion: 6MWD could be a simple and reliable tool to identify a high-risk group of patients post PCI, especially those with previous HF. However, larger adequately powered studies are needed to confirm these findings.

Non ischemic

1357 Hypovolemic Shock Non ischemic 126 Uncertain Non Ischemic 1707 Uncertain Ischemic 97 Respiratory failure

Table 2. Patient outcomes

Patient

Cardiac arrest type

ECC performed

ETCO2 (mmHg)

ROSC

Autopsy LVAD intact LVAD intact LVAD intact NA

1

Aystole

Yes

15

Yes

2

Yes

NA

No

3

Ventricular Fibrillation Asystole

Yes

5

No

4

PEA

No

36

Yes

Figure 1.

Figure 1.

318 Peripartum Cardiomyopathy Network: Medication and Device Therapy Use in the First Year Kismet Rasmusson1, Dennis McNamara2, Deborah Budge1, Abdallah Kfoury1, Uri Elkayam3, Michael Givertz4, Richard Sheppard5, Greg Ewald6, Eileen Hsich7, Kalgi Modi8, Rami Alharethi1; 1Intermountain Heart Institute, Salt Lake City, UT; 2 Univesity of Pittsburgh, Pittsburgh, PA; 3University of Southern California, Los Angeles, CA; 4Brigham and Women’s Hospital, Boston, MA; 5Jewish General, Montreal, QC, Canada; 6Washington University, St. Louis, MO; 7Cleveland Clinic, Cleveland, OH; 8Louisiana State University, Shreveport, LA Background: While guideline directed medical therapy (GDMT) is well established for systolic dysfunction, little is known about its long-term use in patients with Peripartum Cardiomyopathy (PPCM). This study was undertaken to review heart failure (HF) medication and internal cardiovertor defibrillator (ICD) use in a study of 100 patients with PPCM. Methods: The Peripartum Cardiomyopathy Network (PCN) is a previously described network with pooled data of 100 prospectively studied females with PPCM from 30 centers across the U.S. There were no specific protocols for starting or stopping GDMT. Data were analyzed using simple statistics. Baseline was defined as entry into the study (within 2 months of diagnosis), followed by 6- and 12-month data. Results: Of 100 women enrolled in the PCN, 74 had medication- and 76 had echo- documentation at one year (Table 1). At 12 months, survival was 98%, 4 patients received an LVAD, 6 patients wore a Life Vest &/or had ICD implantation, and 77% had recovered