Ruiz Duque Ernesto, Abdelhamid Ahmed, Khalid Muhammad, Kshetri Rupesh, Chlorogiannis Dimitris, Doulamis David Ilias P, Briasoulis Alexandros
Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics, IA, USA.
Department of Radiology, Patras General Hospital, Patras, Greece.
Curr Probl Cardiol. 2023 Feb;48(2):101441. doi: 10.1016/j.cpcardiol.2022.101441. Epub 2022 Oct 8.
Cardiogenic shock (CS) presents with a complex spectrum of low output states, which can be provoked by Acute Coronary Syndrome (ACS) or Acute Decompensated Heart Failure (ADHF). Its management includes hemodynamic assessment via right heart catheterization (RHC). Herein, we describe the timing of RHC based on the etiology and severity of CS as defined by the Society of Cardiovascular Angiography & Interventions (SCAI) Shock Classification. We performed a single-center retrospective analysis of patients admitted with CS secondary to ACS or ADHF from January 7, 2018 to June 30, 2020 at the University of Iowa Hospitals and Clinics. Among the 647 patients admitted, 249 patients had RHC during their admission. Of those, 51 had underlying ACS and 198 had ADHF. The overall time from admission to invasive hemodynamic assessment was 2.73 days. The mean time for SCAI-A was 3.6 ± 2.8 days, SCAI-B 3.7 ± 3.7 days, SCAI-C 2.6 ± 3.0 days, SCAI-D 2.5 ± 4.1 days, and SCAI-E 1.3 ± 2.1 days. The linear regression model showed that RHC was performed earlier in patients with worse hemodynamics evaluated by Cardiac Power Output (CPO) (Coefficient 0.14, R- squared 0.01, P = 0.03). Hemodynamic parameters showed that high PAPi, RVSWi, and Cardiac Power Output during admission predicted low in-hospital mortality (P < 0.01). RHC was performed earlier in more critically ill patients. Patients with CS in the setting of ACS underwent RHC significantly earlier than those with ADHF.
心源性休克（CS）表现为一系列复杂的低输出状态，可由急性冠状动脉综合征（ACS）或急性失代偿性心力衰竭（ADHF）引发。其治疗包括通过右心导管插入术（RHC）进行血流动力学评估。在此，我们根据心血管造影和介入学会（SCAI）休克分类所定义的CS病因和严重程度，描述RHC的时机。我们对2018年1月7日至2020年6月30日在爱荷华大学医院及诊所因ACS或ADHF继发CS入院的患者进行了单中心回顾性分析。在647例入院患者中，249例在住院期间接受了RHC。其中，51例有潜在ACS，198例有ADHF。从入院到有创血流动力学评估的总时间为2.73天。SCAI-A的平均时间为3.6±2.8天，SCAI-B为3.7±3.7天，SCAI-C为2.6±3.0天，SCAI-D为2.5±4.1天，SCAI-E为1.3±2.1天。线性回归模型显示，通过心脏功率输出（CPO）评估血流动力学较差的患者更早进行RHC（系数0.14，决定系数0.01，P = 0.03）。血流动力学参数显示，入院时高肺血管阻力指数（PAPi）、右心室每搏功指数（RVSWi）和心脏功率输出可预测较低的住院死亡率（P < 0.01）。病情更危重的患者更早进行RHC。ACS背景下的CS患者比ADHF患者更早接受RHC。
