Use Of Inotropes Research Articles

Single Ventricular Assist Device Care and Outcomes for Failed Stage I Palliation: A Single-Center Decade of Experience.

Single ventricular assist device (SVAD) use before and after stage I palliation (S1P) is increasing with limited data on outcomes. To address this knowledge gap, we conducted a single-center retrospective review to assess pre- and post-SVAD clinical status, complications, and outcomes. We leveraged a granular, longitudinal, local database that captures end-organ support, procedural interventions, hematologic events, laboratory data, and antithrombotic strategy. We identified 25 patients between 2013 and 2023 implanted at median age of 53 days (interquartile range [IQR] = 16-130); 80% had systemic right ventricles and underwent S1P. Median SVAD days were 54 (IQR = 29-86), and 40% were implanted directly from ECMO. Compared to preimplant, there was a significant reduction in inotrope use ( p = 0.013) and improved weight gain ( p = 0.008) post-SVAD. Complications were frequent including bleeding (80%), stroke (40%), acute kidney injury (AKI) (40%), infection (36%), and unanticipated catheterization (56%). Patients with in-hospital mortality had significantly more bleeding complications ( p = 0.02) and were more likely to have had Blalock-Thomas-Taussig shunts pre-SVAD ( p = 0.028). Survival to 1 year postexplant was 40% and included three recovered and explanted patients. At 1 year posttransplant, all survivors have technology dependence or neurologic injury. This study highlights the clinical outcomes and ongoing support required for successful SVAD use in failed single-ventricle physiology before or after S1P.

Influence of myocardial contractility therapy for advanced heart failure

With more than 5 million patients’ diagnosed with heart failure (HF) and more than 1 million hospitalizations each year, HF continues to have a significant impact on health-care resources. Despite treatment, a significant number of patients continue to have progressive HF symptoms, classified as Class III or IV. The aim of this study was to compare different inotropic therapy for patients of End-Stage Heart Failure. When persistent intravenous access was used and acute hemodynamic improvement was established, the durable medical equipment (DME) benefit category reimbursed 80% of outpatient inotropic medication and supplies for HF. Acute hemodynamic improvement was defined as a 20% reduction in pulmonary capillary wedge pressure and/or a 20% increase in cardiac index, both of which were related to a decrease in dyspnea. The Centers for Medicaid and Medicare Services contracted with regional carriers to run the program. The amounts reimbursed per beneficiary for inotrope and supplies (not adjusted for differential follow-up) were essentially representative of the inotrope cost. Dobutamine, milrinone, and supplies had mean (and median) amounts of 5025 (1168), 87781 (31440), and 7284 (3131), respectively. We found that patients who received this medication had a relatively high death rate, however not as high as people who received chemotherapy. Milrinone-treated patients were compensated more for hospitalizations both before and after starting the inotrope. In addition, the milrinone group had a higher level of digoxin use in the background. Nonetheless, there is an early decrease in overall expenditures following inotrope initiation, which can be attributed to a decrease in hospitalization. Considering the lack of double-blind trials comparing inotropes to placebo or dobutamine to milrinone, decisions regarding the use of inotropes, the type of inotrope used, and the duration of treatment should take into account the impact on resources.

Medical therapy of cardiogenic shock: Contemporary use of inotropes and vasopressors.

Cardiogenic shock is a primary cardiac disorder that results in both clinical and biochemical evidence of tissue hypoperfusion and can lead to multi-organ failure and death depending on its severity. Inadequate cardiac contractility or cardiac power secondary to acute myocardial infarction remains the most frequent cause of cardiogenic shock, although its contribution has declined over the past two decades, compared with other causes. Despite some advances in cardiogenic shock management, this clinical syndrome is still burdened by an extremely high mortality. Its management is based on immediate stabilization of haemodynamic parameters so that further treatment, including mechanical circulatory support and transfer to specialized tertiary care centres, can be accomplished. With these aims, medical therapy, consisting mainly of inotropic drugs and vasopressors, still has a major role. The purpose of this article is to review current evidence on the use of these medications in patients with cardiogenic shock and discuss specific clinical settings with indications to their use.

Sex differences in trends and outcomes of acute myocardial infarction with mechanical complications in the United States

ABSTRACT Background Mechanical complications (MC) are rare but significant sequelae of acute myocardial infarction (AMI). Current data on sex differences in AMI with MC is limited. Methods We queried the National Inpatient Sample database to identify adult patients with the primary diagnosis of AMI and MC. The main outcome of interest was sex difference in-hospital mortality. Secondary outcomes were sex differences in the incidence of acute kidney injury (AKI), major bleeding, use of inotropes, permanent pacemaker implantation (PPMI), performance of percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), surgery (VSD repair and MV surgery), pericardiocentesis, use of mechanical circulatory support (MCS), ischemic stroke, and mechanical ventilation. Results Among AMI-MC cohort, in-hospital mortality was higher among females compared to males (41.24% vs 28.13%: aOR 1.39. 95% CI 1.079–1.798; p = 0.01). Among those who had VSD, females also had higher in-hospital mortality compared to males (56.7% vs 43.1%: aOR 1.74, 95% CI 1.12–2.69; p = 0.01). Females were less likely to receive CABG compared to males (12.03% vs 20%: aOR 0.49 95% CI 0.345–0.690; p < 0.001). Conclusion Despite the decreasing trend in AMI admission, females had higher risk of MC and associated mortality. Significant sex disparities still exist in AMI treatment.

The Impact of Inotropes and Vasopressors on Cerebral Oxygenation in Patients with Traumatic Brain Injury and Subarachnoid Hemorrhage: A Narrative Review.

Traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH) are critical neurological conditions that necessitate specialized care in the Intensive Care Unit (ICU). Managing cerebral perfusion pressure (CPP) and mean arterial pressure (MAP) is of primary importance in these patients. To maintain targeted MAP and CPP, vasopressors and/or inotropes are commonly used. However, their effects on cerebral oxygenation are not fully understood. The aim of this review is to provide an up-to date review regarding the current uses and pathophysiological issues related to the use of vasopressors and inotropes in TBI and SAH patients. According to our findings, despite achieving similar hemodynamic parameters and CPP, the effects of various vasopressors and inotropes on cerebral oxygenation, local CBF and metabolism are heterogeneous. Therefore, a more accurate understanding of the cerebral activity of these medications is crucial for optimizing patient management in the ICU setting.

Single center experience with first-intention high-frequency jet vs. volume-targeted ventilation in extremely preterm neonates.

To examine whether first-intention high-frequency jet ventilation (HFVJ), compared to volume-targeted ventilation (VTV), in extremely preterm infants is associated with lower incidence of bronchopulmonary dysplasia (BPD) and other adverse clinical outcomes. We conducted a retrospective cohort study evaluating neonates with gestational age (GA) ≤28 weeks, who received first-intention HFJV (main exposure) or VTV (comparator), between 11/2020 and 3/2023, with a subgroup analysis including neonates with GA ≤26 weeks and oxygenation index (OI) >5. We identified 117 extremely preterm neonates, 24 (GA 25.2 ± 1.6 weeks) on HFJV, and 93 (GA 26.4 ± 1.5 weeks, p = 0.001) on VTV. The neonates in the HFJV group had higher oxygenation indices on admission, higher inotrope use, and remained intubated for a longer period. Despite these differences, there were no statistically significant differences in rates of BPD, survival, or other adverse outcomes between the two groups. In subgroup analysis of 18 neonates on HFJV and 39 neonates on VTV, no differences were recorded in the GA, and duration of mechanical ventilation, while neonates in the HFJV group had significantly lower rates of BPD (50% compared to 83%, p = 0.034), and no significant differences in other adverse outcomes compared to neonates in the VTV group. In neonates ≤26 weeks of GA with OI >5, HFJV was significantly associated with lower rates of BPD (OR 0.21, 95% CI 0.05-0.92), and combined BPD or death (OR 0.18, 95% CI 0.03-0.85), after adjusting for birth weight, and Arterial-alveolar gradient on admission. In extremely preterm neonates ≤26 weeks of GA with OI >5, first-intention HFJV, in comparison to VTV, is associated with lower rates of BPD.

Frequency and risk factors of delirium in the pediatric intensive care unit of a tertiary care hospital: A prospective observational study

Abstract Background: Critical illness is one of the most common causes of delirium in children which can be associated with increased morbidity and mortality. Delirium continues to be an overlooked aspect of the management of critically ill children. This study was conducted with the objective of determining the frequency and risk factors of delirium in critically ill children. Subjects and Methods: This prospective observational study included patients admitted for at least a period of 24 h of teaching in the pediatric intensive care unit (PICU) of a medical college of Pakistan from March 2022 to September 2022. Each patient was screened for developing delirium twice a day using the Cornell Assessment of Pediatric Delirium. Results: The median age of the patients was 19.5 months (interquartile range: 10.7–72). There were 64.6% (n = 106) of male children, and 97.2% (n = 143) were admitted due to medical conditions. Delirium was identified in 97 (59.1%) patients. Mortality was observed in 3 (1.8%) cases. The average length of stay and frequency of hypoxia was higher among the pediatric delirium group (P = 0.002 and P = 0.022, respectively). Independent predictors of delirium in PICU patients were length of stay (odds ratio [OR], 2.42; 95% confidence interval [CI], 1.39–4.20), use of inotropes (OR, 3.32; 95% CI, 1.0.4–10.64), use of narcotics (OR, 8.78; 95% CI, 0.96–80.51), and hypoxia (OR, 3.02; 95% CI, 1.17–7.81). Conclusion: Delirium is common in children admitted to PICU. Length of PICU stay, use of narcotics, inotropes, and hypoxia were found as independent risk factors for delirium.

Levosimendan: efficacy and safety in pediatric heart failure treatment.

The objective of this study was to assess the effectiveness and safety of levosimendan as an alternative treatment for pediatric patients with decompensated heart failure unresponsive to conventional inotropes and to emphasize its role in enhancing cardiovascular stability. A total of 15 pediatric patients with decompensated heart failure, stemming from acute fulminant myocarditis (53.3%) and post-congenital heart disease surgery complications (46.7%), received levosimendan. The evaluation focused on adverse effects, respiratory support requirements, and concurrent inotropic medication use during levosimendan treatment. Key cardiovascular parameters were assessed at 0, 6, 12, and 24 h post-levosimendan infusion. Levosimendan administration significantly improved key cardiovascular metrics. Left ventricular ejection fraction increased notably from 45±14.8% to 58±15.6% at 24 h (p<0.001). Systolic and diastolic blood pressures rose significantly, with systolic increasing from 79 (68-90) to 98 (89-109) mmHg and diastolic from 47 (40-57) to 66 (54-76) mmHg by 24 h (p<0.001). Heart rate decreased from 162 (111-175) to 132 (99-148) bpm (p=0.02), and lactate levels significantly decreased from 4.15 (2.3-6.5) to 1.85 (0.8-2.6) mmol/L within 6 h (p<0.001). Levosimendan demonstrates its significance in managing pediatric heart failure, indicating its safety and potential to enhance cardiac outcomes by reducing reliance on traditional inotropes.

Spot urinary sodium as a prognostic marker for mortality in patients with acute decompensated heart failure

Introduction. Urinary sodium has been proposed as a prognostic marker and indicator of the diuretic response in patients with heart failure. However, study results are heterogeneous. Objective. To evaluate the spot urinary sodium level as a risk factor for mortality in patients with decompensated heart failure. Materials and methods. We conducted a case-control study nested in a prospective cohort of patients with decompensated heart failure. The primary outcome was mortality at 180 days. The risk factors associated with mortality were evaluated through a bivariate analysis. Differences in clinical variables between groups with urinary sodium greater than or lesser than 70 mEq/L were analyzed. Results. The study included 79 patients; 15 died at 180 days. Their mean age was 68.9 years (SD=± 13.8); 30 were women (38%), and 15 (18.9%) had urinary sodium <70 mEq/L. In the bivariate analysis, a significant association was found between mortality and past medical history of hospitalizations, SBP<90 mm Hg, the use of inotropes, and urinary sodium <70 mEq/L. Regarding clinical characteristics, patients with low urinary sodium level in the last year were hospitalized more frequently with hyponatremia and hypotension at admission. Conclusion. Patients with urinary sodium <70 mEq/L had more severe signs. In a bivariate analysis, urinary sodium was associated with mortality at 180 days.

Pulmonary Artery Catheter Usage and Impact on Mortality in Patients With Cardiogenic Shock: Results From a Canadian Single-Centre Registry

BackgroundHemodynamic assessment for cardiogenic shock (CS) phenotyping in patients has led to renewed interest in the use of pulmonary artery catheters (PACs). MethodsWe included patients admitted with CS from January 2014 to December 2020 and compared clinical outcomes among patients who received PACs and those who did not. The primary outcome was the rate of in-hospital mortality. Secondary outcomes included use of advanced heart failure therapies and coronary intensive care unit (CICU) and hospital lengths of stay. ResultsA total of 1043 patients were analysed and 47% received PACs. Patients selected for PAC-guided management were younger and had lower left ventricular function. They also had higher use of vasopressor and inotropes, and 15.2% of them were already supported with temporary mechanical circulatory support (MCS). In-hospital mortality was lower in patients who received PACs (29.3% vs 36.2%; P = 0.02), mainly driven by a reduction in mortality among those in Society for Cardiovascular Angiography and Interventions (SCAI) stages D and E CS. Patients who received PACs were more likely to receive temporary MCS with Impella, durable ventricular assist devices (VADs), or orthotopic heart transplantation (OHT) (P < 0.001 for all analyses). CICU and hospital lengths of stay were longer in patients who used PACs. ConclusionsAmong patients with CS, the use of PACs was associated with lower in-hospital mortality, especially among those in SCAI stages D and E. Patients who received PACs were also more frequently rescued with temporary MCS or received advanced heart failure therapies, such as durable VADs or OHT.

Vasopressors and inotropes in cardiogenic shock patients: an analysis of the MIMIC-IV database

IntroductionPharmacological support has become the mainstay therapy in patients with cardiogenic shock (CS). Unfortunately, the clinical benefits of such potent drugs remain unclear, therefore, the present study aims to elucidate the safety and efficacy of vasoactive agents in CS patients.MethodsMedical Information Mart for Intensive Care (MIMIC) IV databases were used for this retrospective study. The primary outcome of this study was 30-day all-cause mortality. The subgroup analysis of was the relationship between the combined use of vasopressors and inotropes and 30-day all-cause mortality.ResultsA total of 2,216 patients diagnosed with CS were enrolled in this study. The non-survivors group was more likely to be older, presented with chronic kidney disease, have a lower systolic blood pressure, lower heart rate, and higher respiratory rate (all p &amp;lt; 0.05). In the multivariate Cox regression analysis, only dopamine [HR (95%CI): 1.219 (1.003–1.482)], norepinephrine [HR (95%CI): 2.528 (1.829–3.493)], and milrinone [HR (95%CI): 0.664 (0.512–0.861)] remained an independent predictor for 30-day all-cause mortality. Furthermore, a subgroup analysis was performed and found that no statistically significant difference between no vasopressor/inotrope use and 1 vasopressor/inotrope use (p = 0.107). Meanwhile, a substantial deterioration of cumulative survival was observed when a combination of 2 or more vasopressors/inotropes was used in CS patients in comparison with no vasopressor/inotrope or only 1 vasopressor/inotrope use (all p &amp;lt; 0.05).ConclusionsUsing vasopressors/inotropes agents was associated with a higher risk of 30-day all-cause mortality in CS patients. In addition, only milrinone was associated with a better prognosis among the available vasoactive agents.

Red Cell Distribution Width Is an Independent Predictor of 1-Year Mortality in a Turkish Patient Population with Acute Decompensated Heart Failure

Objective: Heart failure (HF) is a significant public health issue in Turkey. The goal of this study was to look into how red cell distribution width (RDW) affected patients with acute decompensated HF (ADHF) patients' prognoses. Methods: A total of 101 ADHF patients under the age of 18 were enrolled in the study. Venous blood was drawn to measure the serum rdw. After a year of follow-up, the patients' survival status was determined. Results: The patients' mean age was 72. Forty-nine patients had heart failure (HF) with a reduced ejection fraction (EF), 8 had HF with a mildly reduced EF, and 44 had HF with a preserved EF. The median RDW value was 15.9%. In the hospital, nine patients passed away, and 92 others were discharged. 14 patients were lost to follow-up after one year, 87 patients completed the trial, and 40 patients passed away. Inotropic medication use, and serum RDW value were identified as independent predictors of 1-year death in ADHF patients by multivariate logistic regression analysis. According to this data, there was a 44% increase in 1-year mortality for every 1% increase in RDW. Conclusion: In Turkish patients hospitalized for ADHF, red cell distribution width represents an independent prognostic predictor for 1-year mortality.

Analysis of the Association Between the Number of Intensivists and the Use of Cardiovascular Agonists: An Ecological Study Using Data From National Databases of Japan.

Background Previous studies have demonstrated a correlation between management by intensivists and a decrease in hospital stay and mortality, yet the underlying reason remains unknown. Using open data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) and other databses, the present study aimed to explore the relationship between inotrope and vasoconstrictor use and the number of intensivists. Materials and methods Cardiovascular agonists listed in the 2020 NDB for which the total dose was known were included for analysis. Trends in cardiovascular agonist use over six years were then graphically assessed, and a linear regression model with the use of each target drug per prefecture as the objective variable in the 2020 data was created to analyze the impact of intensivists on drug use. Results A total of 61 drugs were classified into eight groups based on their composition, and drug use in each of the 47 prefectures was tabulated. Both the rate of use and cost showed a yearly decrease for dopamine but a yearly increase for norepinephrine. Multivariable analysis indicated that the number of intensivists was only significant for dopamine, which had a coefficient of -310 (95% CI: -548 to -72, p = 0.01) but that no such trend was evident for the other drugs. Conclusions The results demonstrated that an increasing number of intensivists in each prefecture correlated with decreasing use of dopamine, possibly explaining the improved outcomes observed in closed ICUs led by intensivists. Further research is warranted to establish causality.

Cardiogenic shock complicating acute myocardial infarction; mechanical circulatory support use in the Netherlands

Abstract Introduction Mortality rates in cardiogenic shock complicating acute myocardial infarction (AMICS) linger around 40-50%. Despite the lack of evidence, the use of mechanical circulatory support (MCS) in this population is increasing rapidly worldwide. Purpose This study aimed to give insights in MCS use in the Netherlands and to assess how the use of MCS is associated with mortality. Methods Data from all patients undergoing percutaneous coronary intervention (PCI) in the Netherlands is prospectively registered in the Netherlands Heart Registration (NHR) database. On top of the obligatory registration, additional data were retrieved for all patients with cardiogenic shock undergoing PCI between 2017 and 2021 in 14 Dutch hospitals. The additional variables included the use of different types of MCS. Multivariate logistic regression was used to test the association between MCS and mortality in adjustment for confounders. Results In total, we included 2328 patients, with a mean age of 66.4 ± 12.3 years and of whom 72.9% were male. Of all patients, 23.6% received a form of MCS (11.5% an IABP, 4.5% an Impella, 3.1% VA-ECMO, 4.2% a combination of devices and 0.3% other). Compared to patients who did not receive MCS, MCS supported patients were younger (64.2 vs. 67.1 years, p &amp;lt;0.001), presented after an out-of-hospital cardiac arrest (OHCA) less often (33.3% vs. 39.9%, p = 0.008), had complaints for over three hours more often (50.3% vs. 38.8%, p = 0.001) and had a lower mean arterial pressure (MAP) (74.9 vs. 78.6 mmHg, p &amp;lt;0.005) and higher heartrate (88.2 vs 81.8 beats per minute, p &amp;lt;0.001) at admission. Also, mean admission lactate (6.4 vs. 5.2, p &amp;lt;0.001), glucose (13.4 vs. 11.8, p &amp;lt;0.001) and creatinine levels (104 vs. 99, p &amp;lt;0.001) were higher in MCS-receiving patients. Additionally, patients who received MCS support more often suffered from multivessel disease (68.7% vs. 58.4%, p &amp;lt;0.001) and chronic total occlusions (CTO) (3.5% vs. 1.9%, p = 0.027) and were treated with inotropes prior to PCI more often (54.9% vs. 46.2%, p &amp;lt;0.001). The overall 30-day mortality was higher in the MCS cohort than in the no-MCS cohort, namely 54.4% vs. 34.3% (OR = 2.28, 95%CI = 1.88-2.78). In adjustment for age, OHCA, complaints duration, admission MAP, heartrate, lactate, glucose and creatinine, the presence of multivessel disease and CTO and inotrope use before PCI, MCS was independently associated with 30-day mortality (adjusted OR = 2.23, 95% CI = 1.54-3.23). Conclusion MCS was deployed in 23.6% of the patients in this cohort. Despite the results of the IABP-SHOCK II trial, IABP was the most frequently used device. In this cohort, MCS was independently associated with 30-day mortality. However, residual confounding is probably present. Besides randomised controlled trials guiding clinical decision making regarding MCS use and timing, future research should also focus on investigating barriers to implement the results of previous trials.KM-curve of unadjusted survival

Urgent Transcatheter Edge-to-Edge Repair (TEER) of severe mitral regurgitation in patients with cardiogenic shock: A systematic review and meta-analysis of 5,428 patients

Abstract Background Patients presenting with severe mitral valve regurgitation (MR) and cardiogenic shock (CS) demonstrate a poor prognosis and high mortality rate. Transcatheter edge-to-edge repair (TEER) of the mitral valve regurgitation with MitraClip may alter patient management while alleviating hemodynamic instability. Aim To perform a systematic review of the published literature and meta-analysis on the use of MitraClip in patients with severe MR and CS. Methods We performed a systematic review and meta-analysis according to the PRISMA guidelines. We systematically explored published literature in MEDLINE (Pubmed) before January 8, 2023, for studies assessing urgent TEER with MitraClip in patients presenting with severe MR and CS. CS was defined as 1) CS according to ICD-10; 2) inotrope use; or 3) mechanical circulatory support before TEER. The primary outcome was device success and all-cause mortality rates while the secondary outcome was the incidence of myocardial infarction (MI), stroke, and hospitalization for heart failure (HF), during in-hospital/30-days and long-term periods. We calculated I² to test heterogeneity. We used random-effects modeling for the meta-analyses to assess the primary and secondary outcomes. Results In total 25 studies, including 5,428 patients met the predefined eligibility criteria and were included in this meta-analysis. During the in-hospital/30-day period, device success was achieved in 86% (95% CI: 80%-91%, I2 =49%) with MR ≤2+ to be described in 87% (95% CI: 79%-93%, I2 =75.8%) of the cases, while the overall all-cause mortality was 14% (95% CI: 10%-19%, I2 =84%). The incidence of MI and stroke hovered at 4% (95% CI: 1%-13%, I2 =92%) and 2% (95% CI: 1%-2%, I2 =0%), respectively. During a mean follow-up of 10.6 ± 6.4 months, the all-cause mortality was increased to 31% (95% CI: 24%-39%, I2 =92%), while hospitalization for HF is needed in 18% (95% CI: 9%-29%, I2 =80%) of the patients. In the subgroup analysis of patients in CS due to acute MI who underwent urgent TEER, 11 studies and 352 patients were included. Device success was achieved in 92% (95% CI: 75%-100%, I2 =77.8%) and the in-hospital/30-day mortality was 13% (95% CI: 5%-21%, I2 =60%). In a mean follow-up of 10.2 ± 8.3 months, long-term all-cause mortality fluctuated at the same rate of around 11% (95% CI: 2%-23%, I2 =70%). Conclusion The use of MitraClip in patients with MR and concurrent CS is associated with improved in-hospital/30-day and long-term survival. Our findings indicate that using MitraClip in the acute phase is a safe approach that can significantly reduce all-cause mortality, MI, stroke, and re-hospitalization for HF in this patient population.

Abstract 18887: Trends and Outcomes of Use of Inotropes in Cardiac Arrest Survivors With Ventriculartachycardia/Fibrillation

Introduction: Cardiac arrest remains a public health crisis with only 10% overall survival rate. Patients with arrest secondary toventricular tachycardia (VT)/ventricular fibrillation (VF) have relatively better survival rates. Post-arrest shock is usuallycardiogenic due to structural defects at baseline. The outcomes of inotrope use in this population is not well known. Hypothesis: We hypothesized that the use of inotropic support is not associated with better survival outcomes. Methods: This is a cohort study of 387 cardiac arrest patients in a tertiary care center enrolled from January 2012 to December2016 who were able to survive for 24 hours post-cardiopulmonary resuscitation after a VT/VF arrest. We compared thebaseline characteristics and 30-day outcomes of cardiac arrest patient who required inotropes and who did not requireinotropes. Results:Out of 338 cardiac arrest survivors with VT/VF arrest, 99 (29.3%) patients were treated with inotropes. 90 (90.9%) ofpatients in the inotrope group were simultaneously on vasopressors. 30-day mortality was higher (67.7%) in theinotrope group compared to patients with no inotrope use (46.2%). The neurological outcome was worse (cerebralperfusion category ≥3) in patients on inotropes (86.9 vs 63.6%). Conclusions: We observed that mortality was higher in VT/VF cardiac arrest survivors who were on inotropes. These patients hadhigher incidence of vasopressor use and were more likely hemodynamically unstable. Further studies are needed toinvestigate the use and outcomes of inotropes in these subsets of patients.

Abstract 14988: Clinical Impact of Biventricular vs. Isolated Left Ventricular Involvement Among Patients With Takotsubo Cardiomyopathy- An Updated Meta-Analysis

Introduction: Takotsubo Cardiomyopathy (TC) is a form of acute nonischemic cardiomyopathy manifesting as a transient state of cardiac dysfunction. Isolated left ventricular TC (ILVTC) is most commonly observed, less frequently, superimposed right ventricular involvement is apparent - referred to as biventricular TC (BVTC). Few analyses have been done to characterize the implications of biventricular TC on hospital courses and outcomes. Methods: A literature search was conducted on PubMed and Google Scholar to identify qualifying studies. Inclusion criteria were adult patients with TC, and studies reporting comparison of outcomes (cardiogenic shock, use of inotropes, all causes of mortality, and length of hospital stay) between patients with BVTC and ILVTC. Exclusion criteria were any studies that reported on patients younger than 18 years or did not report all the outcomes for BVTC vs ILVTC. Results: A total of 1,156 patients with TC were analyzed from 6 included studies, of which 15% had BVTC (n=175), and 85% had ILVTC (n=981). Patients with BVTC were found to have a higher incidence of cardiogenic shock patients (OR:3.3; 95% CI=1.40-7.77) and use of inotropes (OR:3.66; 95% CI =1.60-8.35). All-cause mortality did not reach statistical significance between the two groups (OR:2.05; 95% CI=0.81 - 5.22; p &lt;0.13). There was also no significant difference in length of hospital stay (Hedges’ g = 0.22; 95% CI = -0.01 to +0.45; p = 0.0593). Conclusions: In comparison to ILVTC, BVTC increasingly predisposes to cardiogenic shock development. Yet, the presence of biventricular involvement does not impact the risk of mortality or hospital length of stay when compared to ILVTC.

Abstract 16368: Opioid Withdrawal-Induced Takotsubo Cardiomyopathy in Hypertrophic Cardiomyopathy

Introduction: This case highlights opioid withdrawal-induced Takotsubo cardiomyopathy (TCM) in a patient with pre-existing hypertrophic cardiomyopathy (HCM) and discusses the concurrent management. Clinical Presentation: An 85-year-old female with HCM, depression, and chronic back pain presented with generalized weakness five days after opioid discontinuation. She exhibited elevated troponin levels and ST elevation in anteroseptal leads, concerning for STEMI. Coronary angiogram revealed nonobstructive coronary artery disease. Transthoracic echocardiogram revealed newly reduced EF 45%, hyperdynamic basal left ventricle, and akinetic mid-distal left ventricle, consistent with TCM. Notably, marked basal anteroseptum thickness and systolic anterior mitral valve motion with left ventricular outflow tract obstruction (LVOTO) and a peak gradient of 92 mmHg. Presentation was complicated by hypotension, pulmonary edema and cardiorenal syndrome. β-blocker use initially deferred, opting for phenylephrine and diuresis until stabilization permitted β-blocker introduction. Discussion: We present a unique case of TCM precipitated by opioid withdrawal in a patient with existing HCM. Standard critical care management for TCM involves hemodynamic support until cardiac function recovers, though the use of vasopressors and inotropes remains controversial. Importantly, this case demonstrates severe provoked LVOTO, mimicking acute myocardial ischemia. Recognizing such scenarios is vital, as inappropriate use of vasodilators or inotropes can be fatal. Class I-IIa recommendations endorse β-blockers and vasoconstrictors for severe provoked LVOTO with hypotension and pulmonary edema. Phenylephrine, a selective α-agonist, maintains LVOT turgidity through preload enhancement, while β-blockers facilitate ventricular filling and reduce LVOT pressure gradient. Further research is warranted as current evidence level remains class C.

Abstract 14817: Influence of Timing of Mechanical Thrombectomy in Treatment of Intermediate-Risk Pulmonary Embolism

Background: Acute pulmonary embolism (PE) is associated with significant morality. Patients with signs of right ventricular (RV) dysfunction are at a high risk of adverse events. Mechanical thrombectomy reduces RV strain and therefore is often performed in intermediate-risk PE. The optimal timing of the procedure is uncertain. We aimed to assess the influence of timing of mechanical thrombectomy on outcomes in patients with intermediate-risk PE. Methods: A single-center, retrospective study collected patient data between 7/2020 and 1/2023. Adults presenting with an intermediate-risk PE who were treated with mechanical thrombectomy were included. Patients with high risk PE were excluded. We compared patient outcomes between individuals receiving intervention within 12 hours of diagnosis (early treatment; ET) to those receiving intervention after 12 hours of diagnosis (delayed treatment, DT). Our primary outcome was change in pulmonary artery pressures. Secondary outcomes included length of stay, intubation rates, vasopressor need and mortality. Results: 69 patients (52% male) were included for analysis. Of these, 37 were included in the ET group and 32 in the DT group. Presenting WHO class was higher in the ET group. Other baseline demographics, presenting vital signs, and echocardiographic parameters were similar between groups (Table). Patients in the ET group had a greater reduction in their pulmonary artery systolic pressure (PASP) after intervention compared to the DT group (-14.8 mm Hg vs. -8.3 mm Hg, p = 0.05; Fig). There were no differences in mortality, intubation rate, vasopressor or inotrope use between groups. There was no significant difference in overall hospital length of stay (LOS), though there was a trend towards shorter ICU LOS in the ET group (1.92 d vs. 4.2 d, p = 0.056). Conclusions: When performed for intermediate-risk PE ET is associated with greater reductions in PASP compared to DT.

Abstract 15264: Impact of 2018 Change in UNOS Heart Transplant Policy on Wait List Outcomes

Introduction: In October 2018, the updated Heart transplant (HT) policy by United network of Organ Sharing (UNOS) gave priority to critically ill heart failure patients. It has made significant improvement in long term survival of ECMO bridged HT recipients. However, there are limited reports on wait list mortality following change in this policy. Hypothesis: Review of waitlist mortality following 2018 change in guideline Methods: This is a retrospective cohort study including all adult heart failure patients listed for HT alone between 2015 and 2022 in the UNOS data. Cohort was stratified on the basis of year of listing, those who listed between 2015 &amp; 2018 and those who listed between 2019 &amp; 2022. The categorical and continuous variables were compared using chi2 and Kruskal Wallis test, respectively. Time to death analysis between both the group was evaluated using Kaplan Meier curve and log rank test. Results: Total 33,908 patients were included, of them 16,281 were listed between 2015 &amp; 2018 and remaining 17,627 were listed between 2019 &amp; 2022. The rate of HT did not change between both the time period (10,660 (65.5%) &amp; 11,660 (66.1%), p=0.19)), respectively. There was no difference in age, gender and BMI between both the groups. The use of Intra-aortic balloon pump, ventilator, Inotropes and other parameters indicating severity of illness were frequently noted among patients listed between 2019 &amp; 2022. The overall wait list mortality has reduced from 1250/16,281(7.7%) to 764/17,627 (4.0%) during later time period, p&lt;0.001 (Figure 1). Similarly, patients’ dropouts due to illness severity has reduced from 1321/16821 (8.1%) to 764/17,627 (4.3%), p&lt;0.001, respectively. There is significant reduction in disease etiology specific mortality following 2018 change. Conclusions: The change in HT policy in 2018 has significantly reduced the wait list mortality and dropouts during study periods. In addition, sicker patients were listed for transplant following 2018 change.