Effect of Microaxial Flow Pump on Hemodynamics in STEMI-Related Cardiogenic Shock

Jacob Eifer Møller; Rasmus Paulin Beske; Lisette Okkels Jensen; Hans Eiskjær; Norman Mangner; Amin Polzin; P Christian Schulze; Carsten Skurk; Peter Nordbeck; Benedikt Schrage; Vasileios Panoulas; Sebastian Zimmer; Andreas Schäfer; Nikos Werner; Lene Holmvang; Jesper Kjærgaard; Thomas Engstøm; Nanna Louise Junker Udesen; Henrik Schmidt; Anders Junker; Kristian Wachtell; Christian Juhl Terkelsen; Steffen Christensen; Axel Linke; Daniel Burkhoff; Christian Hassager; DanGer Shock investigators

doi:10.1016/j.jacc.2025.04.062

Effect of Microaxial Flow Pump on Hemodynamics in STEMI-Related Cardiogenic Shock

Jacob Eifer Møller^*, Rasmus Paulin Beske, Lisette Okkels Jensen, Hans Eiskjær, Norman Mangner, Amin Polzin, P Christian Schulze, Carsten Skurk, Peter Nordbeck, Benedikt Schrage, Vasileios Panoulas, Sebastian Zimmer, Andreas Schäfer, Nikos Werner, Lene Holmvang, Jesper Kjærgaard, Thomas Engstøm, Nanna Louise Junker Udesen, Henrik Schmidt, Anders JunkerKristian Wachtell, Christian Juhl Terkelsen, Steffen Christensen, Axel Linke, Daniel Burkhoff, Christian Hassager, DanGer Shock investigators

^*Corresponding author af dette arbejde

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1 Citationer (Scopus)

Abstract

BACKGROUND: The microaxial flow pump (mAFP) improves survival in selected patients with ST-segment elevation myocardial infarction-induced cardiogenic shock (STEMI-CS). Understanding the impact on cardiac output (CO), cardiac power output (CPO), and pulmonary artery pressure (PAP) provides insight into the potential unloading effect of the device, which is a reduction in total intrinsic mechanical work of the heart.

OBJECTIVE: This study sought to determine the effect of mAFP on hemodynamics in STEMI-CS.

METHODS: This substudy of the DanGer (Danish-German) shock trial randomized patients with STEMI-CS to mAFP or standard of care. Patients were monitored using a pulmonary artery catheter. Outcome measures were CO, CPO, and mean PAP during the first 48 hours.

RESULTS: Of 324 patients admitted to the cardiac intensive care unit (CICU), 223 patients (68%) had data on hemodynamic monitoring: 98 patients (63%) in the standard of care, and 125 (74%) patients in the mAFP group. The median first measured CO after CICU admission was 3.4 L/min (Q1-Q3: 2.6-4.4 L/min) in the control vs 3.7 L/min (Q1-Q3: 3.2-4.5 L/min) in the mAFP group; P = 0.13. After 6 hours, the CO increased in and was consistently higher in the mAFP group from 12 hours until 48 hours. The first measured mean PAP in the CICU had a median value of 31 mm Hg (Q1-Q3: 29-39 mm Hg) in the standard of care group compared with 27 mm Hg (Q1-Q3: 23-33 mm Hg) in the mAFP group (P < 0.001) and remained lower at all time points in the mAFP. Also, the first measured PCWP was lower in mAFP vs standard of care (18 mm Hg [Q1-Q3: 14-22 mm Hg] vs 22 mm Hg [Q1-Q3: 20-26 mm Hg]; P < 0.001) and remained lower until 48 hours. The median first measured CPO was 0.56 W (95% CI: 0.41-0.76 W) in the control vs 0.68 W (95% CI: 0.51-0.85 W; P = 0.01), in the mAFP group, and remained higher in the mAFP group until 48 hours.

CONCLUSIONS: The mAFP reduces intrinsic mechanical work of the heart in STEMI-CS patients enrolled in the DanGer shock trial by reducing native CO, pulmonary pressures, and LV filling pressures while maintaining hydraulic power output delivered to the body by the heart and mAFP (CPO). (Danish Cardiogenic Shock Trial [DanShock]; NCT01633502).

Originalsprog	Engelsk
Tidsskrift	Journal of the American College of Cardiology
Vol/bind	85
Udgave nummer	25
Sider (fra-til)	2456-2468
Antal sider	13
ISSN	0735-1097
DOI	https://doi.org/10.1016/j.jacc.2025.04.062
Status	Udgivet - 1 jul. 2025

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10.1016/j.jacc.2025.04.062

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Møller, J. E., Beske, R. P., Jensen, L. O., Eiskjær, H., Mangner, N., Polzin, A., Schulze, P. C., Skurk, C., Nordbeck, P., Schrage, B., Panoulas, V., Zimmer, S., Schäfer, A., Werner, N., Holmvang, L., Kjærgaard, J., Engstøm, T., Udesen, N. L. J., Schmidt, H., ... DanGer Shock investigators (2025). Effect of Microaxial Flow Pump on Hemodynamics in STEMI-Related Cardiogenic Shock. Journal of the American College of Cardiology, 85(25), 2456-2468. https://doi.org/10.1016/j.jacc.2025.04.062

Møller, JE , Beske, RP, Jensen, LO, Eiskjær, H, Mangner, N, Polzin, A, Schulze, PC, Skurk, C, Nordbeck, P, Schrage, B, Panoulas, V, Zimmer, S, Schäfer, A, Werner, N, Holmvang, L , Kjærgaard, J , Engstøm, T, Udesen, NLJ, Schmidt, H, Junker, A, Wachtell, K, Terkelsen, CJ, Christensen, S, Linke, A, Burkhoff, D, Hassager, C & DanGer Shock investigators 2025, 'Effect of Microaxial Flow Pump on Hemodynamics in STEMI-Related Cardiogenic Shock', Journal of the American College of Cardiology, bind 85, nr. 25, s. 2456-2468. https://doi.org/10.1016/j.jacc.2025.04.062

@article{93828c6f1fa2463db9eb4affd2cbb2f0,

title = "Effect of Microaxial Flow Pump on Hemodynamics in STEMI-Related Cardiogenic Shock",

abstract = "BACKGROUND: The microaxial flow pump (mAFP) improves survival in selected patients with ST-segment elevation myocardial infarction-induced cardiogenic shock (STEMI-CS). Understanding the impact on cardiac output (CO), cardiac power output (CPO), and pulmonary artery pressure (PAP) provides insight into the potential unloading effect of the device, which is a reduction in total intrinsic mechanical work of the heart.OBJECTIVE: This study sought to determine the effect of mAFP on hemodynamics in STEMI-CS.METHODS: This substudy of the DanGer (Danish-German) shock trial randomized patients with STEMI-CS to mAFP or standard of care. Patients were monitored using a pulmonary artery catheter. Outcome measures were CO, CPO, and mean PAP during the first 48 hours.RESULTS: Of 324 patients admitted to the cardiac intensive care unit (CICU), 223 patients (68%) had data on hemodynamic monitoring: 98 patients (63%) in the standard of care, and 125 (74%) patients in the mAFP group. The median first measured CO after CICU admission was 3.4 L/min (Q1-Q3: 2.6-4.4 L/min) in the control vs 3.7 L/min (Q1-Q3: 3.2-4.5 L/min) in the mAFP group; P = 0.13. After 6 hours, the CO increased in and was consistently higher in the mAFP group from 12 hours until 48 hours. The first measured mean PAP in the CICU had a median value of 31 mm Hg (Q1-Q3: 29-39 mm Hg) in the standard of care group compared with 27 mm Hg (Q1-Q3: 23-33 mm Hg) in the mAFP group (P < 0.001) and remained lower at all time points in the mAFP. Also, the first measured PCWP was lower in mAFP vs standard of care (18 mm Hg [Q1-Q3: 14-22 mm Hg] vs 22 mm Hg [Q1-Q3: 20-26 mm Hg]; P < 0.001) and remained lower until 48 hours. The median first measured CPO was 0.56 W (95% CI: 0.41-0.76 W) in the control vs 0.68 W (95% CI: 0.51-0.85 W; P = 0.01), in the mAFP group, and remained higher in the mAFP group until 48 hours.CONCLUSIONS: The mAFP reduces intrinsic mechanical work of the heart in STEMI-CS patients enrolled in the DanGer shock trial by reducing native CO, pulmonary pressures, and LV filling pressures while maintaining hydraulic power output delivered to the body by the heart and mAFP (CPO). (Danish Cardiogenic Shock Trial [DanShock]; NCT01633502).",

keywords = "Humans, Shock, Cardiogenic/physiopathology, Male, Female, ST Elevation Myocardial Infarction/complications, Middle Aged, Aged, Hemodynamics/physiology, Heart-Assist Devices, Cardiac Output/physiology",

author = "M{\o}ller, {Jacob Eifer} and Beske, {Rasmus Paulin} and Jensen, {Lisette Okkels} and Hans Eiskj{\ae}r and Norman Mangner and Amin Polzin and Schulze, {P Christian} and Carsten Skurk and Peter Nordbeck and Benedikt Schrage and Vasileios Panoulas and Sebastian Zimmer and Andreas Sch{\"a}fer and Nikos Werner and Lene Holmvang and Jesper Kj{\ae}rgaard and Thomas Engst{\o}m and Udesen, {Nanna Louise Junker} and Henrik Schmidt and Anders Junker and Kristian Wachtell and Terkelsen, {Christian Juhl} and Steffen Christensen and Axel Linke and Daniel Burkhoff and Christian Hassager and {DanGer Shock investigators}",

year = "2025",

month = jul,

day = "1",

doi = "10.1016/j.jacc.2025.04.062",

language = "English",

volume = "85",

pages = "2456--2468",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier Inc.",

number = "25",

}

TY - JOUR

T1 - Effect of Microaxial Flow Pump on Hemodynamics in STEMI-Related Cardiogenic Shock

AU - Møller, Jacob Eifer

AU - Beske, Rasmus Paulin

AU - Jensen, Lisette Okkels

AU - Eiskjær, Hans

AU - Mangner, Norman

AU - Polzin, Amin

AU - Schulze, P Christian

AU - Skurk, Carsten

AU - Nordbeck, Peter

AU - Schrage, Benedikt

AU - Panoulas, Vasileios

AU - Zimmer, Sebastian

AU - Schäfer, Andreas

AU - Werner, Nikos

AU - Holmvang, Lene

AU - Kjærgaard, Jesper

AU - Engstøm, Thomas

AU - Udesen, Nanna Louise Junker

AU - Schmidt, Henrik

AU - Junker, Anders

AU - Wachtell, Kristian

AU - Terkelsen, Christian Juhl

AU - Christensen, Steffen

AU - Linke, Axel

AU - Burkhoff, Daniel

AU - Hassager, Christian

AU - DanGer Shock investigators

PY - 2025/7/1

Y1 - 2025/7/1

N2 - BACKGROUND: The microaxial flow pump (mAFP) improves survival in selected patients with ST-segment elevation myocardial infarction-induced cardiogenic shock (STEMI-CS). Understanding the impact on cardiac output (CO), cardiac power output (CPO), and pulmonary artery pressure (PAP) provides insight into the potential unloading effect of the device, which is a reduction in total intrinsic mechanical work of the heart.OBJECTIVE: This study sought to determine the effect of mAFP on hemodynamics in STEMI-CS.METHODS: This substudy of the DanGer (Danish-German) shock trial randomized patients with STEMI-CS to mAFP or standard of care. Patients were monitored using a pulmonary artery catheter. Outcome measures were CO, CPO, and mean PAP during the first 48 hours.RESULTS: Of 324 patients admitted to the cardiac intensive care unit (CICU), 223 patients (68%) had data on hemodynamic monitoring: 98 patients (63%) in the standard of care, and 125 (74%) patients in the mAFP group. The median first measured CO after CICU admission was 3.4 L/min (Q1-Q3: 2.6-4.4 L/min) in the control vs 3.7 L/min (Q1-Q3: 3.2-4.5 L/min) in the mAFP group; P = 0.13. After 6 hours, the CO increased in and was consistently higher in the mAFP group from 12 hours until 48 hours. The first measured mean PAP in the CICU had a median value of 31 mm Hg (Q1-Q3: 29-39 mm Hg) in the standard of care group compared with 27 mm Hg (Q1-Q3: 23-33 mm Hg) in the mAFP group (P < 0.001) and remained lower at all time points in the mAFP. Also, the first measured PCWP was lower in mAFP vs standard of care (18 mm Hg [Q1-Q3: 14-22 mm Hg] vs 22 mm Hg [Q1-Q3: 20-26 mm Hg]; P < 0.001) and remained lower until 48 hours. The median first measured CPO was 0.56 W (95% CI: 0.41-0.76 W) in the control vs 0.68 W (95% CI: 0.51-0.85 W; P = 0.01), in the mAFP group, and remained higher in the mAFP group until 48 hours.CONCLUSIONS: The mAFP reduces intrinsic mechanical work of the heart in STEMI-CS patients enrolled in the DanGer shock trial by reducing native CO, pulmonary pressures, and LV filling pressures while maintaining hydraulic power output delivered to the body by the heart and mAFP (CPO). (Danish Cardiogenic Shock Trial [DanShock]; NCT01633502).

AB - BACKGROUND: The microaxial flow pump (mAFP) improves survival in selected patients with ST-segment elevation myocardial infarction-induced cardiogenic shock (STEMI-CS). Understanding the impact on cardiac output (CO), cardiac power output (CPO), and pulmonary artery pressure (PAP) provides insight into the potential unloading effect of the device, which is a reduction in total intrinsic mechanical work of the heart.OBJECTIVE: This study sought to determine the effect of mAFP on hemodynamics in STEMI-CS.METHODS: This substudy of the DanGer (Danish-German) shock trial randomized patients with STEMI-CS to mAFP or standard of care. Patients were monitored using a pulmonary artery catheter. Outcome measures were CO, CPO, and mean PAP during the first 48 hours.RESULTS: Of 324 patients admitted to the cardiac intensive care unit (CICU), 223 patients (68%) had data on hemodynamic monitoring: 98 patients (63%) in the standard of care, and 125 (74%) patients in the mAFP group. The median first measured CO after CICU admission was 3.4 L/min (Q1-Q3: 2.6-4.4 L/min) in the control vs 3.7 L/min (Q1-Q3: 3.2-4.5 L/min) in the mAFP group; P = 0.13. After 6 hours, the CO increased in and was consistently higher in the mAFP group from 12 hours until 48 hours. The first measured mean PAP in the CICU had a median value of 31 mm Hg (Q1-Q3: 29-39 mm Hg) in the standard of care group compared with 27 mm Hg (Q1-Q3: 23-33 mm Hg) in the mAFP group (P < 0.001) and remained lower at all time points in the mAFP. Also, the first measured PCWP was lower in mAFP vs standard of care (18 mm Hg [Q1-Q3: 14-22 mm Hg] vs 22 mm Hg [Q1-Q3: 20-26 mm Hg]; P < 0.001) and remained lower until 48 hours. The median first measured CPO was 0.56 W (95% CI: 0.41-0.76 W) in the control vs 0.68 W (95% CI: 0.51-0.85 W; P = 0.01), in the mAFP group, and remained higher in the mAFP group until 48 hours.CONCLUSIONS: The mAFP reduces intrinsic mechanical work of the heart in STEMI-CS patients enrolled in the DanGer shock trial by reducing native CO, pulmonary pressures, and LV filling pressures while maintaining hydraulic power output delivered to the body by the heart and mAFP (CPO). (Danish Cardiogenic Shock Trial [DanShock]; NCT01633502).

KW - Humans

KW - Shock, Cardiogenic/physiopathology

KW - Male

KW - Female

KW - ST Elevation Myocardial Infarction/complications

KW - Middle Aged

KW - Aged

KW - Hemodynamics/physiology

KW - Heart-Assist Devices

KW - Cardiac Output/physiology

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U2 - 10.1016/j.jacc.2025.04.062

DO - 10.1016/j.jacc.2025.04.062

M3 - Journal article

C2 - 40562510

SN - 0735-1097

VL - 85

SP - 2456

EP - 2468

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 25

ER -

Effect of Microaxial Flow Pump on Hemodynamics in STEMI-Related Cardiogenic Shock

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