Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Department of Medicine, Division of Cardiology, The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts.
J Card Fail. 2021 Oct;27(10):1141-1145. doi: 10.1016/j.cardfail.2021.04.002. Epub 2021 Apr 20.
Sympathetically mediated redistribution of blood from the unstressed venous reservoir to the hemodynamically active stressed compartment is thought to contribute to congestion in cardiogenic shock (CS). We used a novel computational method to estimate stressed blood volume (SBV) in CS and assess its relationship with clinical outcomes.
Hemodynamic parameters including estimated SBV (eSBV) were compared among patients from the Cardiogenic Shock Working Group registry with a complete set of hemodynamic data. eSBV was compared across shock etiologies (acute myocardial infarction and CS (AMI-CS) vs heart failure with CS (HF-CS), Society for Cardiovascular Angiography and Interventions stage, and between survivors and nonsurvivors. Among 528 patients with patients analyzed, the mean eSBV was 2423 mL/70 kg and increased with increasing Society for Cardiovascular Angiography and Interventions stage (B, 2029 mL/70 kg; C, 2305 mL/70 kg; D, 2496 mL/70 kg; E, 2707 mL/70 kg; P < .001). The eSBV was significantly greater among patients with HF-CS who died compared with survivors (2733 vs 2357 mL/70 kg; P < .001), whereas no significant difference was observed between outcome groups in AMI-CS (2501 mL/70 kg vs 2384 mL/70 kg; P = .19).
eSBV is a novel integrated index of congestion which correlates with shock severity. eSBV was higher in patients with HF-CS who died; no difference was observed in patients with AMI-CS, suggesting that congestion may play a more significant role in the deterioration of patients with HF-CS.
从无应激的静脉储备中重新分配血液到血流动力学活跃的应激隔室被认为有助于充血性心力衰竭（CS）引起的充血。我们使用一种新的计算方法来估计 CS 中的应激血容量（SBV）并评估其与临床结局的关系。
比较了具有完整血流动力学数据的 Cardiogenic Shock Working Group 登记处患者的血流动力学参数，包括估计的 SBV（eSBV）。比较了不同休克病因（急性心肌梗死和 CS（AMI-CS）与心力衰竭和 CS（HF-CS）、心血管造影和介入学会分期以及幸存者和非幸存者之间的 eSBV。在分析的 528 例患者中，平均 eSBV 为 2423 mL/70 kg，且随心血管造影和介入学会分期的增加而增加（B 期为 2029 mL/70 kg；C 期为 2305 mL/70 kg；D 期为 2496 mL/70 kg；E 期为 2707 mL/70 kg；P <.001）。HF-CS 中死亡患者的 eSBV 明显高于幸存者（2733 比 2357 mL/70 kg；P <.001），而 AMI-CS 两组间无显著差异（2501 比 2384 mL/70 kg；P =.19）。
eSBV 是充血的新型综合指数，与休克严重程度相关。HF-CS 中死亡患者的 eSBV 更高；AMI-CS 患者之间无差异，提示充血在 HF-CS 患者病情恶化中可能起更重要作用。
