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Published on: June 12, 2021
Characteristics and Outcomes of Patients With Valvular Cardiogenic Shock
Raunak M Nair1, Sanchit Chawla2, Feras Alkhalaileh3
1Cleveland Clinic Heart, Vascular and Thoracic Institute, Cleveland, OH, USA.
Insights
Valvular cardiogenic shock (VCS) affects older females and has worse outcomes than other CS forms. Surgical intervention offers the best results for VCS patients.
Area of Science:
- Cardiology
- Critical Care Medicine
- Cardiac Surgery
Background:
- Clinical characteristics and outcomes of cardiogenic shock (CS) secondary to primary valvular dysfunction (valvular CS or VCS) are not well understood.
- VCS represents a significant subset of CS cases, necessitating further investigation into its unique features and patient trajectories.
Purpose of the Study:
- To characterize the cohort of patients experiencing VCS.
- To compare the outcomes of VCS patients with those suffering from other forms of CS.
Main Methods:
- Retrospective analysis of 2,754 CS patients admitted to a cardiac intensive care unit from 2010 to 2021.
- Comparison of clinical characteristics and outcomes between patients with and without VCS.
Main Results:
- VCS accounted for 16% (442 patients) of CS admissions.
- VCS patients were older, more frequently female, and predominantly had native aortic valve dysfunction.
- VCS was associated with significantly higher 30-day and 1-year all-cause mortality compared to non-VCS.
Conclusions:
- VCS is linked to adverse short- and long-term outcomes.
- Native valve dysfunction, particularly of the aortic valve, is the primary driver of VCS.
- Surgical intervention is associated with superior outcomes in VCS, highlighting the need for timely and definitive treatment strategies.
Background:
The clinical characteristics and outcomes of patients who develop cardiogenic shock (CS) secondary to primary valvular dysfunction (valvular cardiogenic shock [VCS]) remain unclear.
Objectives:
The purpose of this study was to describe the cohort of patients with VCS and understand their outcomes compared to other forms of CS.
Methods:
All patients admitted to Cleveland Clinic cardiac intensive care unit between January 1, 2010, and December 31, 2021, with a diagnosis of CS were retrospectively identified. Characteristics and outcomes for shock patients with VCS were compared to those without VCS.
Results:
A total of 2,754 patients were admitted to our cardiac intensive care unit with CS, of which 442 (16%) had VCS. The median age of patients with VCS was higher than those with non-VCS (70 years vs 64 years, P < 0.001) and were more likely females (40.3% vs 32.1%, P = 0.001). VCS was predominantly due to native valve dysfunction as compared to prosthetic valve dysfunction (71% vs 29%, P < 0.001), with the aortic valve noted to be the most common valve affected. Patients with VCS had higher 1-year (44% vs 37%, P < 0.001) and 30-day all-cause mortality (28% vs 20%, P < 0.001) compared to those without VCS. When compared to percutaneous intervention and medical therapy alone, surgical intervention in VCS was associated with the best short- and long-term outcomes (P < 0.001).
Conclusions:
VCS is associated with poor short and long outcomes. Native valvular dysfunction and aortic valve involvement account for the majority of patients with VCS. Definitive surgical therapy and expanding the role of percutaneous therapies may be pivotal in improving clinical outcomes in this high-risk cohort.
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