Prognostic Significance of Hemodynamic Parameters in Patients with Cardiogenic Shock.
Publication/Presentation Date
8-28-2023
Abstract
BACKGROUND: Invasive hemodynamic assessment with a pulmonary artery catheter is often used to guide management of patients with cardiogenic shock (CS) and may provide important prognostic information. We aimed to assess prognostic associations and relationships to end-organ dysfunction of presenting hemodynamic parameters in CS.
METHODS: The Critical Care Cardiology Trials Network (CCCTN) is an investigator-initiated multicenter registry of cardiac intensive care units (CICUs) in North America coordinated by the TIMI Study Group. Patients with CS (2018-2022) who underwent invasive hemodynamic assessment within 24 hours of CICU admission were included. Associations of hemodynamic parameters with in-hospital mortality were assessed using logistic regression, and associations with presenting serum lactate were assessed using least squares means regression. Sensitivity analyses were performed excluding patients on temporary mechanical circulatory support and adjusted for vasoactive-inotropic score.
RESULTS: Among the 3,603 admissions with CS, 1,473 had hemodynamic data collected within 24 hours of CICU admission. Median cardiac index was 1.9 (IQR, 1.6-2.4) L/min/m2 and mean arterial pressure (MAP) was 74 (66-86) mmHg. Parameters associated with mortality included low MAP, low systolic blood pressure, low systemic vascular resistance, elevated right atrial pressure (RAP), elevated RAP/pulmonary capillary wedge pressure ratio, and low pulmonary artery pulsatility index. These associations were generally consistent when controlling for intensity of background pharmacologic and mechanical hemodynamic support. These parameters were also associated with higher presenting serum lactate.
CONCLUSIONS: In a contemporary CS population, presenting hemodynamic parameters reflecting decreased systemic arterial tone and indicators of right ventricular dysfunction are associated with adverse outcomes and presenting lactate.
ISSN
2048-8734
Published In/Presented At
Berg, D. D., Kaur, G., Bohula, E. A., Baird-Zars, V. M., Alviar, C. L., Barnett, C. F., Barsness, G. W., Burke, J. A., Chaudhry, S. P., Chonde, M., Cooper, H. A., Daniels, L. B., Dodson, M. W., Gerber, D. A., Ghafghazi, S., Gidwani, U. K., Goldfarb, M. J., Guo, J., Hillerson, D., Kenigsberg, B. B., … Morrow, D. A. (2023). Prognostic Significance of Hemodynamic Parameters in Patients with Cardiogenic Shock. European heart journal. Acute cardiovascular care, zuad095. Advance online publication. https://doi.org/10.1093/ehjacc/zuad095
Disciplines
Medicine and Health Sciences
PubMedID
37640029
Department(s)
Department of Medicine, Cardiology Division
Document Type
Article