Echocardiographic Characteristics of Cardiogenic Shock Patients with and Without Cardiac Arrest
Meir Tabi1, Narayana Sarma V Singam2, Brandon Wiley1
1Department of Cardiovascular Medicine, 6915Mayo Clinic, Rochester MN, US.
Insights
Cardiac arrest (CA) in cardiogenic shock (CS) patients significantly increases mortality. Right ventricular dysfunction, not left ventricular function, predicts outcomes in these critically ill patients.
Area of Science:
- Cardiology
- Critical Care Medicine
- Echocardiography
Background:
- Cardiac arrest (CA) is linked to poorer outcomes in patients experiencing cardiogenic shock (CS).
- Understanding the specific impact of CA on CS is crucial for improving patient management.
- Transthoracic echocardiography (TTE) offers valuable insights into cardiac function in these complex cases.
Purpose of the Study:
- To compare transthoracic echocardiography (TTE) parameters between cardiogenic shock (CS) patients with and without cardiac arrest (CA).
- To identify echocardiographic predictors of in-hospital mortality in CS patients, differentiating between those with and without prior CA.
Main Methods:
- Retrospective analysis of 1085 cardiogenic shock (CS) patients admitted to a cardiac intensive care unit between 2007 and 2018.
- Comparison of left ventricular (LV) and right ventricular (RV) TTE measurements in patients with and without cardiac arrest (CA).
- Multivariable logistic regression used to determine the primary outcome of all-cause in-hospital mortality.
Main Results:
- 35% of CS patients experienced cardiac arrest (CA), exhibiting higher illness severity and greater need for mechanical ventilation and vasopressors.
- In-hospital mortality was significantly higher in CS patients with CA (45% vs. 23%, p <0.001).
- While LV ejection fraction was similar, CA patients showed reduced cardiac index and mitral inflow velocities; RV function and pressure parameters predicted mortality in CA patients, whereas LV systolic function was key in non-CA patients.
Conclusions:
- Right ventricular (RV) systolic dysfunction, assessed by Doppler, is the strongest predictor of mortality in cardiogenic shock (CS) patients following cardiac arrest (CA).
- Left ventricular (LV) systolic function is a more significant predictor of mortality in CS patients without CA.
- RV assessment is critical for accurate mortality risk stratification in CS patients who have experienced CA.
Background:
Cardiac arrest (CA) is associated with worse outcomes in patients with cardiogenic shock (CS). To better understand the contribution of CA on CS, we evaluated transthoracic echocardiography (TTE) parameters in CS patients with and without CA.
Methods:
We retrospectively identified CS patients with a TTE performed near cardiac intensive care unit admission between 2007 to 2018. We compared TTE measurements of left ventricular (LV) and right ventricular (RV) function in patients with and without CA. The primary outcome was all-cause in-hospital mortality, as determined using multivariable logistic regression.
Results:
We included 1085 patients, 35% of whom had CA. Median age was 70 years and 37% were females. CA patients had higher severity of illness, more invasive mechanical ventilation and greater vasopressor/inotrope use. In-hospital mortality was 31% and was higher in CA patients (45% vs. 23%, p <0.001). Although LV ejection fraction (LVEF) was similar (35% vs. 37%, p = 0.05), CA patients had lower cardiac index, mitral valve E wave peak velocity, E/A ratio and E/e' ratio. TTE variables that were associated with hospital mortality varied, among patients with CA, these included measures of RV pressure and function and among patients without CA, these included parameters reflecting LV systolic function.
Conclusions:
Doppler assessments of RV systolic dysfunction were the strongest TTE predictors of hospital mortality in CS patients with CA, unlike CS patients without CA in whom LV systolic function was more important. This emphasizes the importance of RV assessment for mortality risk stratification after CA.
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