Related Experiment Video
Updated: Jun 21, 2025
Continuous Venous-Arterial Doppler Ultrasound During a Preload Challenge
Published on: January 20, 2023
Comprehensive non-invasive haemodynamic assessment in acute decompensated heart failure-related cardiogenic shock: a
Simone Frea1, Carol Gravinese1, Paolo Boretto1
1Division of Cardiology, Cardiovascular and Thoracic Department, "Citta della Salute e della Scienza" Hospital, Italy.
Insights
Echocardiography can accurately assess hemodynamics in cardiogenic shock (CS) patients with acute decompensated heart failure. This non-invasive method shows good agreement with invasive assessments, aiding in CS phenotyping and management.
Area of Science:
- Cardiology
- Critical Care Medicine
- Medical Imaging
Background:
- Cardiogenic shock (CS) management relies on accurate hemodynamic assessment.
- Phenotyping CS is crucial for guiding treatment strategies.
- Acute decompensated heart failure (ADHF) is a common cause of CS.
Purpose of the Study:
- To evaluate the correlation between echocardiographic and invasive hemodynamic assessments in ADHF-CS patients.
- To determine the feasibility of echocardiography for CS phenotyping.
- To compare non-invasive hemodynamic estimates with right heart catheterization data.
Main Methods:
- Prospective enrollment of 101 ADHF-CS patients (SCAI shock stage ≥B) undergoing right heart catheterization (RHC).
- Echocardiography performed 30 minutes prior to RHC.
- Correlation analysis of echocardiographic estimates (e.g., eCI, eWP, ePAP, eCPO, ePAPi) with invasive parameters (CI, WP, PAP, CPO, PAPi).
Main Results:
- Good correlation (Pearson r > 0.8) observed for cardiac index (CI), systolic pulmonary artery pressure (PAP), right atrial pressure (RAP), and cardiac power output (CPO).
- Moderate correlation for estimated pulmonary artery pulsatility index (ePAPPi) and pulmonary vascular resistance (PVR).
- Echocardiographic phenotyping showed good agreement with invasive classification (K=0.457, P < 0.001).
Conclusions:
- Echocardiographic estimation of hemodynamics is feasible in ADHF-CS.
- Non-invasive assessment demonstrates good agreement with invasive hemodynamic evaluation.
- Echocardiography can aid in the phenotyping of cardiogenic shock.
Aims:
Haemodynamic assessment can be determinant in phenotyping cardiogenic shock (CS) and guiding patient management. Aim of this study was to evaluate the correlation between echocardiographic and invasive assessment of haemodynamics in acute decompensated heart failure-related CS (ADHF-CS).
Methods And Results:
All consecutive ADHF-CS patients (SCAI shock stage ≥B) undergoing right heart catheterization (RHC) between 2020 and 2022 were prospectively enrolled. Patients underwent echocardiography 30 min before RHC. The evaluated haemodynamic parameters and their echocardiographic estimates ('e') comprised cardiac index (CI), wedge pressure (WP), pulmonary artery pressures (PAP), cardiac power output (CPO) and pulmonary artery pulsatility index (PAPi). Hundred and one ADHF-CS patients (56 ± 11 years, 64% SCAI shock stage C, left ventricular ejection fraction 29 ± 5%) were included. Good correlation was found for CI, systolic PAP, RAP, and CPO (Pearson r > 0.8 for all), moderate correlation for ePAPi (r = 0.67) and PVR (r = 0.51), while estimation of WP was weak. The sensitivity and specificity of eCI to identify low output state (CI ≤2.2 L/min/m2) were 0.97 and 0.73, respectively, those of eWP for elevated filling pressures (WP >15 mmHg) were 0.84 and 0.55, those of ePAPs for PAPs ≥35 mmHg were 0.87 and 0.63, those of eCPO for CPO <0.6 W were 0.76 and 0.85, those of ePAPi for PAPi <1.85 were 0.89 and 0.92. Echocardiographic phenotyping of CS showed a good agreement with invasive classification (K value 0.457, P < 0.001).
Conclusion:
Echocardiographic estimation of haemodynamics and subsequent phenotypization of CS is feasible with good agreement with invasive evaluation.
