Davila Carlos D, Esposito Michele, Hirst Colin S, Morine Kevin, Jorde Lena, Newman Sarah, Paruchuri Vikram, Whitehead Evan, Thayer Katherine L, Kapur Navin K
The Cardiovascular Center at Tufts Medical Center, Tufts University School of Medicine, Boston, MA, United States.
Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
Front Cardiovasc Med. 2021 Feb 11;8:563853. doi: 10.3389/fcvm.2021.563853. eCollection 2021.
We describe the association between longitudinal hemodynamic changes and clinical outcomes in patients with cardiogenic shock (CS) receiving acute mechanical circulatory support devices (AMCS) at a single center. We hypothesized that improved right atrial pressure is associated with better survival in CS. Retrospective analysis of patients from Tufts Medical Center that received AMCS for CS. Baseline characteristics and invasive hemodynamics were collected, analyzed, and correlated against outcomes. Hemodynamics were recorded at different time intervals during index admission [pre-AMCS, 24 h after AMCS (post AMCS), and last available set of hemodynamics (final-AMCS)]. Logistic regression was performed to determine variables associated with in-hospital mortality. A total of 76 patients had longitudinal hemodynamics available. In hospital mortality occurred in 46% of the cohort. Mean baseline right atrial pressure (RAP) was significantly higher among non-survivors vs. survivors (19.5+6.6 vs. 16.4+5.3 mmHg). Change in right atrial pressure from baseline to before device removal (ΔRA:final AMCS-pre AMCS) was significantly different between survivors and non survivors (-6.5 ± 6.9 mmHg vs. -2.5 ± 6.2 mmHg = 0.03). Unadjusted logistic regression revealed baseline RAP (OR: 1.1 95% CI: 1.0-1.2), 24 h post device implant RAP (OR: 1.3 95% CI: 1.1-1.4), and final RAP (OR: 1.3 95% CI: 1.1-1.5) to be significant predictors of in-hospital mortality. In a multivariate logistic regression baseline RAP was no longer significantly associated with mortality in the overall cohort, while 24 h (OR: 1.26 95% CI: 1.1-1.5) and final RAP (OR: 1.3 95% CI: 1.1-1.6) remained statistically significant. We report a novel retrospective analysis of hemodynamic changes in patients with CS receiving AMCS. Our findings identify the potential importance of venous congestion as a prognostic marker of mortality. Furthermore, early decongestion or reduced RA pressure is associated with better survival in these critically ill CS patients. These observations suggest the need for further study in larger retrospective and prospective cohorts of patients with varying degrees of CS severity.
我们描述了在单一中心接受急性机械循环支持装置（AMCS）的心源性休克（CS）患者中，纵向血流动力学变化与临床结局之间的关联。我们假设右心房压力改善与CS患者更好的生存率相关。对塔夫茨医学中心接受AMCS治疗CS的患者进行回顾性分析。收集、分析基线特征和有创血流动力学数据，并与结局进行关联分析。在索引住院期间的不同时间间隔记录血流动力学数据[AMCS前、AMCS后24小时（AMCS后）以及最后一组可用的血流动力学数据（最终AMCS）]。进行逻辑回归以确定与院内死亡率相关的变量。共有76例患者有纵向血流动力学数据。该队列中46%的患者发生院内死亡。非幸存者的平均基线右心房压力（RAP）显著高于幸存者（19.5±6.6 vs. 16.4±5.3 mmHg）。幸存者和非幸存者从基线到装置移除前右心房压力的变化（ΔRA：最终AMCS - AMCS前）有显著差异（-6.5±6.9 mmHg vs. -2.5±6.2 mmHg，P = 0.03）。未调整的逻辑回归显示基线RAP（OR：1.1，95%CI：1.0 - 1.2）、装置植入后24小时的RAP（OR：1.3，95%CI：1.1 - 1.4）和最终RAP（OR：1.3，95%CI：1.1 - 1.5）是院内死亡率的显著预测因素。在多变量逻辑回归中，基线RAP在整个队列中不再与死亡率显著相关，而24小时（OR：1.26，
