Cherbi Miloud, Bonnefoy Eric, Lamblin Nicolas, Gerbaud Edouard, Bonello Laurent, Roubille François, Levy Bruno, Champion Sebastien, Lim Pascal, Schneider Francis, Elbaz Meyer, Khachab Hadi, Bourenne Jeremy, Seronde Marie-France, Schurtz Guillaume, Harbaoui Brahim, Vanzetto Gerald, Combaret Nicolas, Labbe Vincent, Marchandot Benjamin, Lattuca Benoit, Biendel-Picquet Caroline, Leurent Guillaume, Puymirat Etienne, Maury Philippe, Delmas Clément
Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France.
Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France.
Front Cardiovasc Med. 2023 Sep 5;10:1167738. doi: 10.3389/fcvm.2023.1167738. eCollection 2023.
Cardiogenic shock (CS) is the most severe form of heart failure (HF), resulting in high early and long-term mortality. Characteristics of CS secondary to supraventricular tachycardia (SVT) are poorly reported. Based on a large registry of unselected CS, we aimed to compare 1-year outcomes between SVT-triggered and non-SVT-triggered CS.
FRENSHOCK is a French prospective registry including 772 CS patients from 49 centers. For each patient, the investigator could report 1-3 CS triggers from a pre-established list (ischemic, mechanical complications, ventricular/supraventricular arrhythmia, bradycardia, iatrogenesis, infection, non-compliance, and others). In this study, 1-year outcomes [rehospitalizations, mortality, heart transplantation (HTx), ventricular assist devices (VAD)] were analyzed and adjusted for independent predictive factors.
Among 769 CS patients included, 100 were SVT-triggered (13%), of which 65 had SVT as an exclusive trigger (8.5%). SVT-triggered CS patients exhibited a higher proportion of male individuals with a more frequent history of cardiomyopathy or chronic kidney disease and more profound CS (biventricular failure and multiorgan failure). At 1 year, there was no difference in all-cause mortality (43% vs. 45.3%, adjusted HR 0.9 (95% CI 0.59-1.39), = 0.64), need for HTx or VAD [10% vs. 10%, aOR 0.88 (0.41-1.88), = 0.74], or rehospitalizations [49.4% vs. 44.4%, aOR 1.24 (0.78-1.98), = 0.36]. Patients with SVT as an exclusive trigger presented more 1-year rehospitalizations [52.8% vs. 43.3%, aOR 3.74 (1.05-10.5), = 0.01].
SVT is a frequent trigger of CS alone or in association in more than 10% of miscellaneous CS cases. Although SVT-triggered CS patients were more comorbid with more pre-existing cardiomyopathies and HF incidences, they presented similar rates of mortality, HTx, and VAD at 1 year, arguing for a better overall prognosis.
https://clinicaltrials.gov, identifier: NCT02703038.
心源性休克（CS）是心力衰竭（HF）最严重的形式，导致早期和长期高死亡率。关于室上性心动过速（SVT）继发的心源性休克的特征报道较少。基于一个大型的未选择的心源性休克登记研究，我们旨在比较SVT诱发的心源性休克和非SVT诱发的心源性休克的1年结局。
FRESHOCK是一项法国前瞻性登记研究，纳入了来自49个中心的772例心源性休克患者。对于每位患者，研究者可从预先设定的列表（缺血、机械并发症、室性/室上性心律失常、心动过缓、医源性、感染、不依从及其他）中报告1 - 3个心源性休克触发因素。在本研究中，分析了1年结局[再次住院、死亡率、心脏移植（HTx）、心室辅助装置（VAD）]，并对独立预测因素进行了校正。
在纳入的769例心源性休克患者中，100例由SVT诱发（13%），其中65例以SVT作为唯一触发因素（8.5%）。SVT诱发的心源性休克患者中男性比例较高，有心肌病或慢性肾脏病病史者更常见，且心源性休克更严重（双心室衰竭和多器官衰竭）。1年时，全因死亡率（43%对45.3%，校正后HR 0.9（95%CI 0.59 - 1.39），P = 0.64）、心脏移植或心室辅助装置需求[10%对10%，校正后OR 0.88（0.41 - 1.88），P = 0.74]或再次住院率[49.4%对44.4%，校正后OR 1.24（0.78 - 1.98），P = 0.36]无差异。以SVT作为唯一触发因素的患者1年再次住院率更高[52.8%对43.3%，校正后OR 3.74（1.05 - 10.5），P = 0.01]。
在超过10%的混合性心源性休克病例中，SVT单独或合并其他因素是心源性休克的常见触发因素。尽管SVT诱发的心源性休克患者合并更多的既往心肌病和心力衰竭发生率，但他们1年时的死亡率、心脏移植和心室辅助装置使用率相似，提示总体预后较好。
