What does this research mean for the field?

Increasing Impella 5.5 support improves right ventricular stroke volume in healthy hearts, but this compensatory right ventricular reserve is significantly attenuated following acute myocardial infarction. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To assess the mechanistic impact of graded Impella 5.5 mechanical circulatory support on biventricular pressure–volume hemodynamics before and after acute myocardial infarction.

September 28, 2026Journal of the American Heart AssociationOpen Access

Biventricular Pressure–Volume Loop Assessment of Impella 5.5 in an Acute ST‐Segment–Elevation Myocardial Infarction Shock Model Unmasks Diminished Right Ventricular Reserve

Q: What are the key findings of this study?

Increasing Impella 5.5 support improved median RV stroke volume by 50.6% in healthy porcine hearts (P<0.05), but this response was attenuated to 13.4% following acute myocardial infarction (P=0.94).

Q: What is the clinical evidence from this study?

Population: Acute ST-Segment-Elevation Myocardial Infarction Shock (n=6). Intervention: Impella 5.5 support vs. Healthy heart (before myocardial infarction). Primary outcome: Median RV stroke volume percentage change at maximum tolerated support.

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Key result

Impella 5.5 support increases RV stroke volume ~51% in healthy porcine hearts but fails post-MI.

Why the study?

Mechanistic understanding of biventricular relationships during Impella 5.5 support in acute myocardial infarction is essential for device optimization.

Does Impella 5.5 support alter biventricular hemodynamics in a porcine model of acute myocardial infarction?

Population

Domestic Yorkshire pigs with acute myocardial infarction (n=6)

Comparison

Impella 5.5 support before versus after myocardial infarction

Design

Preclinical study with biventricular pressure–volume loop assessment

Authors

SISara S. InglisMayo Clinic SRSerena Rahme SRSkylar A. RizzoMayo Clinic

Discussion

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Implication

Attenuated RV response to Impella after infarction in porcine hearts should not change practice; hypothesis-generating for mechanical support in human cardiogenic shock.

Key Points

To assess the mechanistic impact of graded Impella 5.5 mechanical circulatory support on biventricular pressure–volume hemodynamics before and after acute myocardial infarction.
Percutaneous placement of Impella 5.5 was performed via carotid/aortic access under fluoroscopic guidance in domestic Yorkshire pigs.
Biventricular pressure–volume loops and derived hemodynamic parameters were measured across support levels (P-levels) before (n=6) and after (n=6) induction of acute myocardial infarction.
Increasing Impella 5.5 support shifted left ventricular pressure–volume loops leftward and right ventricular (RV) loops rightward across conditions.
Before infarction, median RV stroke volume significantly increased from P1 (5.7%, IQR -15.1% to 9.7%) to P9 (50.6%, IQR -11.6% to 60.2%; P < 0.05).
Following acute myocardial infarction, animals were unable to tolerate support levels beyond P7, with median RV stroke volume changing from 3.9% (IQR -2.7% to 78.4%) at P1 to only 13.4% (IQR -8.9% to 147.2%; P = 0.94) at P7.

Structured PICO

Does Impella 5.5 support alter biventricular hemodynamics in a porcine model of acute myocardial infarction?

Population

6 Domestic Yorkshire pigs evaluated before and after creation of an acute myocardial infarction to assess Impella 5.5 biventricular hemodynamics.

Intervention

Impella 5.5 inserted percutaneously via carotid/aortic access with speed modulation (P levels)

Comparator

Healthy state (before myocardial infarction) vs. acute myocardial infarction state

Outcome

Biventricular pressure-volume loops and derived parameters, including right ventricular stroke volume percentage changesurrogate

Main Result

Absolute Event Rate: 13.4% vs 50.6%

In a porcine model of acute myocardial infarction, increasing Impella 5.5 support unmasks diminished right ventricular reserve, limiting the ability to tolerate higher device speeds.

Cite This Study

Inglis et al. (2026) studied Acute ST-Segment-Elevation Myocardial Infarction Shock (n=6). Impella 5.5 support vs. Healthy heart (before myocardial infarction) was evaluated on Median RV stroke volume percentage change at maximum tolerated support. Increasing Impella 5.5 support improved median RV stroke volume by 50.6% in healthy porcine hearts (P<0.05), but this response was attenuated to 13.4% following acute myocardial infarction (P=0.94).

synapsesocial.com/papers/6ab9b5c47822ec8fc3d90c2d https://doi.org/10.1161/jaha.125.047609

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Implication

Attenuated RV response to Impella after infarction in porcine hearts should not change practice; hypothesis-generating for mechanical support in human cardiogenic shock.

Biventricular Pressure–Volume Loop Assessment of Impella 5.5 in an Acute ST‐Segment–Elevation Myocardial Infarction Shock Model Unmasks Diminished Right Ventricular Reserve

Discussion

Member takes

Implication

Key Points

Structured PICO

Main Result

Cite This Study

Biventricular Pressure–Volume Loop Assessment of Impella 5.5 in an Acute ST‐Segment–Elevation Myocardial Infarction Shock Model Unmasks Diminished Right Ventricular Reserve

Discussion

Member takes

Implication

Key Points

Structured PICO

Main Result

Cite This Study

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