Author + information
- Received January 16, 2013
- Revision received February 28, 2013
- Accepted March 6, 2013
- Published online June 1, 2013.
- Nishant R. Shah, MD∗,
- Mark C. Bieniarz, MD†,
- Sukhdeep S. Basra, MD, MPH‡,
- Robert D. Paisley, MD§,
- Pranav Loyalka, MD‖,
- Igor D. Gregoric, MD‖,
- Douglas L. Mann, MD¶ and
- Biswajit Kar, MD‖∗ ()
- ↵∗Reprint requests and correspondence:
Dr. Biswajit Kar, Center for Advanced Heart Failure, University of Texas Health Sciences Center, 6410 Fannin Street, Suite 920, Houston, Texas 77030.
Objectives The aim of this study was to characterize levels of serum biomarkers in patients with severe refractory cardiogenic shock (SRCS) and to document temporal changes in these levels during restoration of circulation.
Background Patients with SRCS have been challenging to study because of their rapidly changing clinical condition while undergoing multiple simultaneous interventions.
Methods Twenty-one patients with SRCS received circulatory support via a percutaneously implanted ventricular assist device (PVAD). Serum samples obtained prior to PVAD support initiation, at 24 h of PVAD support, and at 7 days of PVAD support were assayed for B-type natriuretic peptide (BNP), high-sensitivity C-reactive protein (hsCRP), soluble tumor necrosis factor receptor-1 (sTNFR1), soluble Fas (sFas), soluble Fas ligand (sFasL), endothelin-1, and procollagen III N-terminal peptide (PIIINP). Baseline biomarker levels were qualitatively compared to reference values; levels at 24 h of PVAD support and at 7 days of PVAD support were compared to baseline using 2-tailed Wilcoxon matched pair signed rank tests with Bonferroni correction for multiple comparisons.
Results These patients with SRCS had elevated serum levels of BNP, hsCRP, sTNFR1, endothelin-1, and PIIINP. Ventricular unloading and restoration of circulation via PVAD support in patients with SRCS were associated with reductions in serum BNP, sFas, and endothelin-1 levels and increases in serum sFasL and PIIINP levels.
Conclusions This study characterizes several important baseline serum biomarker levels in patients with SRCS and introduces a novel PVAD-based protocol with the potential to "reverse"-model the pathophysiology of cardiogenic shock.
The views expressed are those of the authors and should not be construed to represent the positions of the U.S. Department of the Army, or the U.S. Department of Defense. This study was funded solely by Roderick D. MacDonald research grant no. 07RDM007 awarded by St. Luke’s Episcopal Hospital, Houston, Texas. Although the Texas Heart Institute has been a training center for Cardiac-Assist, Inc. (Pittsburgh, Pennsylvania) (the manufacturer of the percutaneously implanted ventricular assist device used in this study) since 2009, all of the patients in this study were recruited prior to the establishment of this relationship. Dr. Loyalka is a consultant to St. Jude Medical and Boston Scientific; and is a proctor for St. Jude Medical for which he has received financial support. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 16, 2013.
- Revision received February 28, 2013.
- Accepted March 6, 2013.
- American College of Cardiology Foundation