Whitehead Evan H, Thayer Katherine L, Burkhoff Daniel, Uriel Nir, Ohman E Magnus, O'Neill William, Kapur Navin K
Tufts Medical Center, Cardiovascular Center for Research and Innovation, Boston, MA, United States.
Cardiovascular Research Foundation, New York, NY, United States.
Front Cardiovasc Med. 2020 Aug 28;7:155. doi: 10.3389/fcvm.2020.00155. eCollection 2020.
Right ventricular failure (RVF) is associated with increased mortality among patients receiving left ventricular mechanical circulatory support (LV-MCS) for cardiogenic shock and requires prompt recognition and management. Increased central venous pressure (CVP) is an indicator of potential RVF. We studied whether elevated CVP during LV-MCS for acute myocardial infarction complicated by cardiogenic shock is associated with higher mortality. Between January 2014 and June 2019, we analyzed hemodynamic parameters during Impella LV-MCS from 28 centers in the United States participating in the global, prospective catheter-based ventricular assist device (cVAD) study. A total of 132 patients with a documented CVP measurement while on Impella left-sided support for cardiogenic shock were identified. CVP was significantly higher among patients who died in the hospital (14.0 vs. 11.7 mmHg, = 0.014), and a CVP >12 identified patients at significantly higher risk for in-hospital mortality (65 vs. 45%, = 0.02). CVP remained significantly associated with in-hospital mortality even after adjustment in a multivariable model (adjusted OR 1.10 [95% CI 1.02-1.19] per 1 mmHg increase). LV-MCS suction events were non-significantly more frequent among patients with high vs. low CVP (62.11 vs. 7.14 events, = 0.067). CVP is a single, readily accessible hemodynamic parameter which predicts a higher rate of short-term mortality and may identify subclinical RVF in patients receiving LV-MCS for cardiogenic shock.
右心室衰竭（RVF）与因心源性休克接受左心室机械循环支持（LV-MCS）的患者死亡率增加相关，需要及时识别和处理。中心静脉压（CVP）升高是潜在RVF的一个指标。我们研究了急性心肌梗死合并心源性休克患者在接受LV-MCS期间CVP升高是否与更高的死亡率相关。在2014年1月至2019年6月期间，我们分析了美国28个参与全球前瞻性导管介入式心室辅助装置（cVAD）研究中心的Impella LV-MCS期间的血流动力学参数。共识别出132例在接受Impella左侧支持治疗心源性休克时有CVP测量记录的患者。住院死亡患者的CVP显著更高（14.0 vs. 11.7 mmHg，P = 0.014），CVP>12的患者院内死亡风险显著更高（65% vs. 45%，P = 0.02）。即使在多变量模型调整后，CVP仍与院内死亡率显著相关（每升高1 mmHg，调整后的OR为1.10 [95% CI 1.02 - 1.19]）。CVP高的患者与CVP低的患者相比，LV-MCS抽吸事件的发生频率无显著差异（62.11次 vs. 7.14次事件，P = 0.067）。CVP是一个单一的、易于获取的血流动力学参数，可预测较高的短期死亡率，并可能识别接受LV-MCS治疗心源性休克患者的亚临床RVF。
