Division of Cardiology, Trillium Health Partners, University of Toronto, ON.
Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta Hospital, Edmonton, AB, Canada.
Chest. 2022 Mar;161(3):697-709. doi: 10.1016/j.chest.2021.09.032. Epub 2021 Oct 2.
Ventricular function, including left ventricular systolic dysfunction (LVSD), right ventricular systolic dysfunction (RVSD), and biventricular dysfunction (BVD), contribute to shock in cardiac ICU (CICU) patients, but the prognostic usefulness remains unclear.
Do patients with ventricular dysfunction have higher mortality at each Society for Cardiovascular Angiography and Intervention (SCAI) shock stage?
We identified patients in the CICU admitted with available echocardiography data. LVSD was defined as left ventricular ejection fraction < 40%, RVSD as moderate or greater systolic dysfunction by semiquantitative measurement, and BVD as the presence of both. Multivariate logistic regression determined the relationship between ventricular dysfunction and adjusted in-hospital mortality as a function of SCAI stage.
The study population included 3,158 patients with a mean ± SD age of 68.2 ± 14.6 years, of which 51.8% had acute coronary syndromes. LVSD was present in 22.3%, RVSD in 11.8%, and BVD in 16.4%. After adjustment for SCAI shock stage, no difference in in-hospital mortality was found between patients with LVSD or RVSD and those without ventricular dysfunction (P > .05), but BVD was associated independently with higher in-hospital mortality (adjusted hazard ratio, 1.815; 95% CI, 1.237-2.663; P = .0023). The addition of ventricular dysfunction to the SCAI staging criteria increased discrimination for hospital mortality (area under the receiver operating characteristic curve, 0.784 vs 0.766; P < .001).
Among patients admitted to the CICU, only BVD was associated independently with higher hospital mortality. The addition of echocardiography assessment to the SCAI shock criteria may facilitate improved clinical risk stratification.
心室功能，包括左心室收缩功能障碍（LVSD）、右心室收缩功能障碍（RVSD）和双心室功能障碍（BVD），与心脏重症监护病房（CICU）患者的休克有关，但预后的有用性仍不清楚。
在每个心血管造影和介入学会（SCAI）休克阶段，患有心室功能障碍的患者死亡率是否更高？
我们在 CICU 中确定了有可用超声心动图数据的患者。LVSD 定义为左心室射血分数<40%，RVSD 定义为通过半定量测量中度或更严重的收缩功能障碍，BVD 定义为两者同时存在。多变量逻辑回归确定了心室功能障碍与 SCAI 阶段调整住院死亡率之间的关系。
研究人群包括 3158 名平均年龄为 68.2±14.6 岁的患者，其中 51.8%患有急性冠状动脉综合征。LVSD 的发生率为 22.3%，RVSD 的发生率为 11.8%，BVD 的发生率为 16.4%。在调整 SCAI 休克阶段后，LVSD 或 RVSD 患者与无心室功能障碍患者的住院死亡率无差异（P>0.05），但 BVD 与较高的住院死亡率独立相关（调整后的危险比为 1.815；95%置信区间，1.237-2.663；P=0.0023）。将心室功能障碍纳入 SCAI 分期标准可提高对医院死亡率的区分度（接受者操作特征曲线下面积，0.784 比 0.766；P<0.001）。
在入住 CICU 的患者中，只有 BVD 与较高的医院死亡率独立相关。将超声心动图评估纳入 SCAI 休克标准可能有助于改善临床风险分层。
