Fincke Rupert, Hochman Judith S, Lowe April M, Menon Venu, Slater James N, Webb John G, LeJemtel Thierry H, Cotter Gad
New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York, USA.
J Am Coll Cardiol. 2004 Jul 21;44(2):340-8. doi: 10.1016/j.jacc.2004.03.060.
We sought to analyze clinical, angiographic, and outcome correlates of hemodynamic parameters in cardiogenic shock.
The significance of right heart catheterization in critically ill patients is controversial, despite the prognostic importance of the derived measurements. Cardiac power is a novel hemodynamic parameter.
A total of 541 patients with cardiogenic shock who were enrolled in the SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK (SHOCK) trial registry were included. Cardiac power output (CPO) (W) was calculated as mean arterial pressure x cardiac output/451.
On univariate analysis, CPO, cardiac power index (CPI), cardiac output, cardiac index, stroke volume, left ventricular work, left ventricular work index, stroke work, mean arterial pressure, systolic and diastolic blood pressure (all p < 0.001), coronary perfusion pressure (p = 0.002), ejection fraction (p = 0.013), and pulmonary artery systolic pressure (p = 0.047) were associated with in-hospital mortality. In separate multivariate analyses, CPO (odds ratio per 0.20 W: 0.60 [95% confidence interval, 0.44 to 0.83], p = 0.002; n = 181) and CPI (odds ratio per 0.10 W/m(2): 0.65 [95% confidence interval, 0.48 to 0.87], p = 0.004; n = 178) remained the strongest independent hemodynamic correlates of in-hospital mortality after adjusting for age and history of hypertension. There was an inverse correlation between CPI and age (correlation coefficient: -0.334, p < 0.001). Women had a lower CPI than men (0.29 +/- 0.11 vs. 0.35 +/- 0.15 W/m(2), p = 0.005). After adjusting for age, female gender remained associated with CPI (p = 0.032).
Cardiac power is the strongest independent hemodynamic correlate of in-hospital mortality in patients with cardiogenic shock. Increasing age and female gender are independently associated with lower cardiac power.
我们试图分析心源性休克患者血流动力学参数的临床、血管造影及预后相关性。
尽管右心导管检查所获测量值对预后很重要，但在危重症患者中的意义仍存在争议。心脏功率是一种新的血流动力学参数。
纳入应紧急对心源性休克患者闭塞冠状动脉进行血运重建（SHOCK）试验登记中的541例心源性休克患者。心脏功率输出（CPO）（瓦）计算为平均动脉压×心输出量/451。
单因素分析显示，CPO、心脏功率指数（CPI）、心输出量、心脏指数、每搏量、左心室作功、左心室作功指数、每搏功、平均动脉压、收缩压和舒张压（均p<0.001）、冠状动脉灌注压（p=0.002）、射血分数（p=0.013）及肺动脉收缩压（p=0.047）与院内死亡率相关。在单独的多因素分析中，调整年龄和高血压病史后，CPO（每0.20瓦的比值比：0.60[95%置信区间，0.44至0.83]，p=0.002；n=181）和CPI（每0.10瓦/平方米的比值比：0.65[95%置信区间，0.48至0.87]，p=0.004；n=178）仍是院内死亡率最强的独立血流动力学相关因素。CPI与年龄呈负相关（相关系数：-0.334，p<0.001）。女性的CPI低于男性（0.29±0.11 vs. 0.35±0.15瓦/平方米，p=0.005）。调整年龄后，女性性别仍与CPI相关（p=0.032）。
心脏功率是心源性休克患者院内死亡率最强的独立血流动力学相关因素。年龄增加和女性性别与较低的心脏功率独立相关。
Zotero 插件