Abstract 2382: Effects of Short-term Left Ventricular Assist Devices on Serum Concentration of Cerebral Biomarkers in Patients Undergoing Percutaneous Coronary Intervention
Background and Objectives: Increased serum concentrations of the brain-derived proteins neuron-specific enolase (NSE) and S-100b are used as early predictors of neurologic outcome after CPR. According to first clinical findings, we evaluated possible interaction between use of left ventricular assist devices (LVAD) and validity of these prognostic serum markers in elective patients.
Methods: The study included eighty non-resuscitated patients who received a LVAD (IABP or axial flow pump) during PCI: 15 patients received the short-term LVAD support for high-risk angioplasty, 34 due to severe myocardial infarction associated with acute heart failure, and 31 due to profound cardiogenic shock.
Results: Eleven patients (14 %) did not survive; the remaining 69 patients (86 %) survived and were discharged home from hospital. We observed a significant decline of thrombocytes count, and of hemoglobin concentrations during LVAD support. We observed elevated NSE serum levels above the upper limit of normal (ULN) in 93.6% of all serum samples. In addition, we unexpectedly found S-100b serum levels above ULN in 58.6% of patients. Those patients who suffered from cardiogenic shock showed significantly higher serum concentrations of both neuroproteins than those patients without cardiogenic shock. The use of axial flow pumps leads to significantly higher serum concentrations of NSE compared to patients on an IABP, but not of S-100b. The length of IABP support did not correlate with the increase of serum concentration of both neuroproteins.
Conclusions: LVAD support can lead to a significant increase in NSE serum concentrations as well as in S-100b. The increase in NSE can be explained primarily by alteration of thrombocytes and other blood cells. However, the increase in serum levels of S-100b remains unexplained, as S-100b does not occur in peripheral blood cells. A cerebral release of both neuroproteins caused by micro-embolic events caused by the PCI or the use of LVAD support could be possible. An overestimation of the extent of hypoxic brain damage in CPR survivors may result if LVAD support and PCI is applied. Further studies are necessary to determine the cause of increase in S-100b serum concentrations under such conditions.