Predictors of the need for escalation therapy in patients with cardiogenic shock treated with an Impella device: a novel approach using electrocardiography.

Cardiogenic shock has a high mortality rate. Even with the use of the Impella device, there are certain number of cases require further escalation therapy, although the predictive factors have not been fully elucidated. In this study, we aimed to estimate the acute mortality rate and the rate of requiring escalation therapy, as well as evaluate the predictors of the need for escalation therapy, including electrocardiographic parameters. In this retrospective study, we analyzed the patients with cardiogenic shock on Impella support between April 2018 and June 2021. Electrocardiogram, serum lactate levels, and pulmonary artery catheterization parameters were assessed 12 h after Impella implantation. Patients who died or required escalation therapy within 30 days of Impella implantation were defined as the deteriorated group and the remaining as the recovered group. A total of 67 patients with cardiogenic shock (66 ± 16 years; 46 men) with Impella were evaluated. The 30-day mortality rate and rate of requiring escalation therapy were 24% and 18%, respectively. The P terminal force in lead V1 (PTF) was significantly higher in the deteriorated group than in the recovered group (0.052 ± 0.032 vs. 0.022 ± 0.010 mm·s, respectively; p < 0.001). On receiver-operating characteristics curve analysis, PTF ≥ 0.035 mm·s identified the deteriorated group with a sensitivity of 73% and specificity of 96% (area under the curve = 0.93, p < 0.001). PTF might be a new simple noninvasive predictor of the need for escalation therapy in patients with an implanted Impella.