University of Texas Medical Branch, Galveston, Texas.
Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania.
J Card Fail. 2024 Oct;30(10):1196-1207. doi: 10.1016/j.cardfail.2024.06.019.
Cardiogenic shock (CS) is a hemodynamic syndrome that can progress to systemic metabolic derangements and end-organ dysfunction. Prior studies have reported hemodynamic parameters at the time of admission to be associated with mortality but hemodynamic trajectories in CS have not been well described. We studied the association between hemodynamic profiles and their trajectories and in-hospital mortality in patients with CS due to heart failure (HF-CS) and acute myocardial infarction (MI-CS). Using data from the large multicenter Cardiogenic Shock Working Group (CSWG) registry, we analyzed hemodynamic data obtained at the time of pulmonary artery catheter (PAC) insertion (dataset at baseline) and at PAC removal or death (dataset at final time point). Univariable regression analyses for prediction of in-hospital mortality were conducted for baseline and final hemodynamic values, as well as the interval change (delta-P). Data was further analyzed based on CS etiology and survival status. A total of 2260 patients with PAC data were included (70% male, age 61 ± 14 years, 61% HF-CS, 27% MI-CS). In-hospital mortality was higher in the MI-CS group (40.1%) compared with HF-CS (22.4%, P < .01). In the HF-CS cohort, survivors exhibited lower right atrial pressure (RAP), pulmonary artery pressure (PAP), cardiac output/index (CO/CI), lactate, and higher blood pressure (BP) than nonsurvivors at baseline. In this cohort, during hospitalization, improvement in metabolic (aspartate transaminase, lactate), BP, hemodynamic (RAP, pulmonary artery pulsatility index [PAPi], pulmonary artery compliance for right-sided profile and CO/CI for left-sided profile), had association with survival. In the MI-CS cohort, a lower systolic BP and higher PAP at baseline were associated with odds of death. Improvement in metabolic (lactate), BP, hemodynamic (RAP, PAPi for right-sided profile and CO/CI for left-sided profile) were associated with survival. In a large contemporary CS registry, hemodynamic trajectories had a strong association with short-term outcomes in both cohorts. These findings suggest the clinical importance of timing and monitoring hemodynamic trajectories to tailor management in patients with CS.
心原性休克（CS）是一种血流动力学综合征，可导致全身代谢紊乱和终末器官功能障碍。先前的研究报告称，入院时的血流动力学参数与死亡率有关，但 CS 的血流动力学轨迹尚未得到很好的描述。我们研究了心力衰竭（HF-CS）和急性心肌梗死（MI-CS）所致 CS 患者的血流动力学特征及其轨迹与院内死亡率之间的关系。利用大型多中心心原性休克工作组（CSWG）注册中心的数据，我们分析了肺动脉导管（PAC）插入时（基线数据集）和 PAC 拔除或死亡时（最终时间点数据集）获得的血流动力学数据。对基线和最终血流动力学值以及间隔变化（delta-P）进行了用于预测院内死亡率的单变量回归分析。还根据 CS 的病因和生存状况对数据进行了进一步分析。共纳入 2260 例 PAC 数据患者（70%为男性，年龄 61±14 岁，61%为 HF-CS，27%为 MI-CS）。MI-CS 组的院内死亡率（40.1%）高于 HF-CS 组（22.4%，P<.01）。HF-CS 队列中，幸存者的基线右心房压（RAP）、肺动脉压（PAP）、心输出量/指数（CO/CI）、乳酸和血压（BP）均低于非幸存者。在此队列中，住院期间代谢（天冬氨酸转氨酶、乳酸）、BP、血流动力学（RAP、肺动脉搏动指数[PAPi]、右侧血流动力学的肺动脉顺应性和左侧血流动力学的 CO/CI）的改善与存活相关。在 MI-CS 队列中，基线时较低的收缩压和较高的 PAP 与死亡的几率相关。代谢（乳酸）、BP、血流动力学（RAP、右侧血流动力学的 PAPi 和左侧血流动力学的 CO/CI）的改善与存活相关。在一个大型当代 CS 注册中心中，两组的血流动力学轨迹均与短期结局密切相关。这些发现表明，监测 CS 患者的血流动力学轨迹对于调整治疗具有重要的临床意义。
