In-hospital mortality associated with cardiogenic shock (CS) remains high despite the use of percutaneous assist devices. We sought to determine whether support with VA-ECMO or Impella in patients with CS alters specific components of the plasma proteome. Plasma samples were collected before device implantation and 72 h after initiation of support in 11 CS patients receiving ECMO or Impella. SOMAscan was used to detect 1305 circulating proteins. Sixty-seven proteins were changed after ECMO (18 upregulated and 49 downregulated, p < 0.05), 38 after Impella (10 upregulated and 28 downregulated, p < 0.05), and only eight proteins were commonly affected. Despite minimal protein overlap, both devices were associated with markers of reduced inflammation and increased apoptosis of inflammatory cells. In summary, ECMO and Impella are associated with reduced expression of inflammatory markers and increased markers of inflammatory cell death. These circulating proteins may serve as novel targets of therapy or biomarkers to tailor AMCS use.

Graphical Abstract

Patients with refractory cardiogenic shock (CS) present with increased levels of circulating proteins related to inflammation, apoptosis, and necrosis and decreased levels of circulating proteins related to angiogenesis. After 72 h of acute mechanical circulatory support (AMCS), there is reduction of circulating proteins related to inflammation, while proteins related to apoptosis and necrosis remain elevated.

中文翻译：

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循环蛋白质组分析表明心源性休克患者通过静脉-动脉体外膜氧合或叶轮启动血流动力学支持后炎症减轻

尽管使用了经皮辅助装置，但与心源性休克（CS）相关的院内死亡率仍然很高。我们试图确定 CS 患者的 VA-ECMO 或 Impella 支持是否会改变血浆蛋白质组的特定成分。在 11 名接受 ECMO 或 Impella 的 CS 患者中，在装置植入前和开始支持后 72 小时收集血浆样本。SOMAscan 用于检测 1305 种循环蛋白。ECMO 后有 67 个蛋白质发生变化（18 个上调，49 个下调，p  < 0.05），Impella 后有 38 个蛋白质发生变化（10 个上调，28 个下调，p  < 0.05），只有 8 个蛋白质受到普遍影响。尽管蛋白质重叠极小，但这两种装置都与减少炎症和增加炎症细胞凋亡的标志物相关。总之，ECMO 和 Impella 与炎症标志物表达减少和炎症细胞死亡标志物增加有关。这些循环蛋白可以作为新的治疗靶标或生物标志物来定制 AMCS 的使用。

图形概要

难治性心源性休克（CS）患者表现出与炎症、细胞凋亡和坏死相关的循环蛋白水平升高，以及与血管生成相关的循环蛋白水平降低。急性机械循环支持（AMCS）72小时后，与炎症相关的循环蛋白减少，而与细胞凋亡和坏死相关的蛋白仍然升高。