Prognostic Significance of Haemodynamic Parameters in Patients With Cardiogenic Shock

Authors

David D. Berg, Levine Cardiac Intensive Care Unit, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Suite 7022, Boston, MA 02115, USA.
Gurleen Kaur, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Erin A. Bohula, Levine Cardiac Intensive Care Unit, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Suite 7022, Boston, MA 02115, USA.
Vivian M. Baird-Zars, Levine Cardiac Intensive Care Unit, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Suite 7022, Boston, MA 02115, USA.
Carlos L. Alviar, Leon H Charney Division of Cardiology, Bellevue Hospital Center, New York University School of Medicine, New York, NY, USA.
Christopher F. Barnett, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
Gregory W. Barsness, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
James A. Burke, Division of Cardiology, Lehigh Valley Heart Network, Allentown, PA, USA.
Sunit-Preet Chaudhry, Department of Medicine, St Vincent Heart Center, Indianapolis, IN, USA.
Meshe Chonde, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Howard A. Cooper, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
Lori B. Daniels, Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
Mark W. Dodson, Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT, USA.
Daniel A. Gerber, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Shahab Ghafghazi, Cardiovascular Medicine, University of Louisville, Louisville, KY, USA.
Umesh K. Gidwani, Division of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Michael J. Goldfarb, Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada.
Jianping Guo, Levine Cardiac Intensive Care Unit, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Suite 7022, Boston, MA 02115, USA.
Dustin Hillerson, Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Benjamin B. Kenigsberg, Departments of Cardiology and Critical Care, MedStar Washington Hospital Center, Washington, DC, USA.
Ajar Kochar, Levine Cardiac Intensive Care Unit, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Suite 7022, Boston, MA 02115, USA.
Michael C. Kontos, Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
Younghoon Kwon, Division of Cardiology, University of Washington, Seattle, WA, USA.
Mathew S. Lopes, Levine Cardiac Intensive Care Unit, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Suite 7022, Boston, MA 02115, USA.
Daniel B. Loriaux, Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA.
P Elliott Miller, Section of Cardiovascular Medicine, Yale University, New Haven, CT, USA.
Connor G. O'Brien, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
Alexander I. Papolos, Departments of Cardiology and Critical Care, MedStar Washington Hospital Center, Washington, DC, USA.
Siddharth M. Patel, Levine Cardiac Intensive Care Unit, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Suite 7022, Boston, MA 02115, USA.
Barbara A. Pisani, Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
Brian J. Potter, Cardiology Service, Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM) Research Center and Cardiovascular Center, Montreal, QC, Canada.
Rajnish Prasad, Division of Cardiology, Wellstar Health System, Marietta, GA, USA.

Author Type(s)

Faculty

Journal Title

European Heart Journal. Acute Cardiovascular Care

First Page

651

Last Page

660

Document Type

Article

Publication Date

10-25-2023

Department

Medicine

Abstract

AIMS: Invasive haemodynamic assessment with a pulmonary artery catheter is often used to guide the 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 haemodynamic parameters in CS. METHODS AND RESULTS: The Critical Care Cardiology Trials Network 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 haemodynamic assessment within 24 h of CICU admission were included. Associations of haemodynamic 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. Among the 3603 admissions with CS, 1473 had haemodynamic data collected within 24 h of CICU admission. The median cardiac index was 1.9 (25th-75th percentile, 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 the intensity of background pharmacologic and mechanical haemodynamic support. These parameters were also associated with higher presenting serum lactate. CONCLUSION: In a contemporary CS population, presenting haemodynamic parameters reflecting decreased systemic arterial tone and right ventricular dysfunction are associated with adverse outcomes and systemic hypoperfusion.

Recommended Citation

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., 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., Kochar, A., Kontos, M. C., Kwon, Y., Lopes, M. S., Loriaux, D. B., Miller, P. E., O'Brien, C. G., Papolos, A. I., Patel, S. M., Pisani, B. A., Potter, B. J., & Prasad, R. (2023). Prognostic Significance of Haemodynamic Parameters in Patients With Cardiogenic Shock. European Heart Journal. Acute Cardiovascular Care, 12 (10), 651-660. https://doi.org/10.1093/ehjacc/zuad095