Association of Shock Index with Echocardiographic Parameters in Cardiac Intensive Care Unit.

Authors

Meir Tabi
Mitchell Padkins
Barry Burstein
Anan Younis
Elad Asher
Courtney E Bennett DO, Lehigh Valley Health NetworkFollow
Jacob C Jentzer

Publication/Presentation Date

10-25-2023

Abstract

BACKGROUND: A high shock index (SI), the ratio of heart rate (HR) to systolic blood pressure (SBP), has been associated with unfavorable outcomes. We sought to determine the hemodynamic underpinnings of an elevated SI using 2-D and doppler Transthoracic Echocardiography (TTE) in unselected cardiac intensive care unit (CICU) patients.

METHODS: We included Mayo Clinic CICU admissions from 2007 to 2018 who were in sinus rhythm at the time of TTE. The SI was calculated using HR and SBP at the time of TTE. Patients were grouped according to SI:

RESULTS: We included 6289 unique CICU patients, 58% of whom had acute coronary syndrome. The median age was 67.9 years old and 37.8% were females. The mean SI was 0.67 BPM/mmHg. As the SI increased, markers of left ventricular (LV) systolic function and forward flow decreased, including left ventricular ejection fraction (LVEF), fractional shortening, left ventricular outflow tract (LVOT) velocity time integral (VTI), stroke volume, LV stroke work index, and cardiac power output. Biventricular filling pressures increased, and markers of right ventricular function worsened with rising SI. Most TTE measurements reflecting LV function and forward flow were inversely correlated with SI, including LV stroke work index (r = -0.59) and LVOT VTI (r = -0.41), as were both systemic vascular resistance index (r = -0.43) and LVEF (r = -0.23).

CONCLUSION: CICU patients with elevated SI have worse biventricular function and systemic hemodynamics, particularly decreased stroke volume and related calculated TTE parameters. The SI is an easily available marker that can be used to identify CICU patients with unfavorable hemodynamics who may require further assessment.

Volume

79

First Page

154445

Last Page

154445

ISSN

1557-8615

Published In/Presented At

Tabi, M., Padkins, M., Burstein, B., Younis, A., Asher, E., Bennett, C., & Jentzer, J. C. (2023). Association of Shock Index with Echocardiographic Parameters in Cardiac Intensive Care Unit. Journal of critical care, 79, 154445. Advance online publication. https://doi.org/10.1016/j.jcrc.2023.154445

Disciplines

Medicine and Health Sciences

PubMedID

37890356

Department(s)

Department of Medicine

Document Type

Article