2026-04-10 国立循環器病研究センター
＜関連情報＞
- https://www.ncvc.go.jp/res/topics/topics_13531/
- https://onlinejcf.com/article/S1071-9164(26)00073-4/abstract
経皮的補助循環装置単独療法および静脈動脈体外式膜型人工肺併用療法で治療された心原性ショックにおける時間的血行動態パターン Temporal Hemodynamic Patterns in Cardiogenic Shock Treated With Isolated Percutaneous Ventricular Assist Device and Combined Therapy With Venoarterial Extracorporeal Membrane Oxygenation
KANAKO TERAMOTO, MD, PhD, MPH ∙ KEITA SAKU, MD, PhD ∙ YUKI IKEDA, MD, PhD ∙ … ∙ TAKESHI YAMAMOTO, MD, PhD ∙ TOMOHIRO SAKAMOTO, MD, PhD ∙ JUNYA AKO, MD, PhD
Journal of Cardiac Failure Published:February 18, 2026
DOI:https://doi.org/10.1016/j.cardfail.2026.01.012
Graphical Abstract
Visual Take-Home Graphic. Longitudinal collection of hemodynamic indices and temporal change during mAFP support.
Highlights
- In patients with cardiogenic shock undergoing temporary mechanical circulatory support (MCS), hemodynamic trends differed between patients with isolated microaxial flow pump (mAFP) and additional mAFP on VA-ECMO.
- Patients with isolated mAFP showed progressive declines in atrial pressures, achieving a >10-mm Hg reduction in pulmonary artery wedge pressure (PAWP) and 5 mm Hg in right atrial pressure. However, improvement patterns in hemodynamic indices were not different between survivors and non-survivors.
- Patients receiving additional mAFP on VA-ECMO demonstrated rapid increases in cardiac output (COPAC), CPO, API, and MPS during the weaning phase of temporary MCS, along with reductions in PAWP and RAP. In survivors, additional improvements in PAWP and diastolic pulmonary arterial pressure (DPAP) were observed after VA-ECMO explantation.
- Temporal trends in arterial pressures and functional indices may help to assess the degree of functional recovery during temporary MCS in patients receiving combination therapy.
Abstract
Background
This study aimed to describe hemodynamic trends in patients with cardiogenic shock who received either isolated microaxial flow pump (mAFP) support or additional mAFP on venoarterial extracorporeal membrane oxygenation support (ie, VA-ECMO + mAFP). Trends also were analyzed by hospital survival in each group.
Methods
Using mixed-effect models, we analyzed hemodynamic indices from pre-, post-, and 24 hours after mAFP installation to immediately before device explantation in patients from the UNLOADERS-PVAD (UNLoading and heart recOvery with ADvanced mEchanical ciRculatory Support: optimal management of Percutaneous Ventricular Assist Device) Registry, a Japanese multicenter registry of patients with cardiogenic shock receiving mAFP.
Results
Hemodynamic indices from 409 patients (mean age 67 years, 75% male; 206 with isolated mAFP and 203 with VA-ECMO + mAFP) were analyzed. From immediately before mAFP installation to immediately before mAFP explantation, the mAFP group achieved an 11.8-mm Hg decrease in pulmonary artery wedge pressure, a 5.8-mm Hg decrease in right atrial pressure, and a 1.32 L/min increase in cardiac output (COPAC). Similarly, the ECMO + mAFP group showed a 2.8 L/min and 0.4 W increase in COPAC and cardiac power output, respectively. Changing patterns of hemodynamic indices were comparable between survivors and nonsurvivors with isolated mAFP support. In the ECMO + mAFP group, survivors demonstrated additional increases in COPAC, aortic pulsatility index, and myocardial performance score as well as reductions in pulmonary artery wedge pressure and diastolic pulmonary arterial pressure after VA-ECMO explantation.
Conclusions
Patients with mAFP for cardiogenic shock exhibited progressive decreases in atrial pressures and increases in cardiac output, with distinct patterns in survivors receiving mAFP in addition to VA-ECMO. Hemodynamic monitoring may help determine the extent of cardiac recovery during combination therapy.
