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Updated: May 27, 2025
Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
Published on: August 16, 2021
Characteristics and Outcomes of Patients With Cardiogenic Shock and Clinically Significant Valvular Heart Disease:
Anthony P Carnicelli1, P Elliott Miller2, David D Berg3
1Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC.
Insights
Valvular heart disease (VHD) causes cardiogenic shock (CS) in a small fraction of cardiac intensive care unit admissions but is linked to significantly higher in-hospital mortality rates.
Area of Science:
- Cardiology
- Critical Care Medicine
- Valvular Heart Disease
Background:
- Cardiogenic shock (CS) is a severe complication that can arise from valvular heart disease (VHD).
- Understanding the impact of VHD on CS outcomes is crucial for intensive care management.
Purpose of the Study:
- To analyze cardiac intensive care unit (CICU) admissions based on the presence and causality of VHD in patients with CS.
- To compare demographics, therapies, and mortality rates between CS patients with and without VHD.
Main Methods:
- Data from 5242 CS admissions across tertiary CICUs from 2017-2023 were analyzed.
- Admissions were categorized into CS attributed to VHD, CS with noncausative VHD, and CS without severe VHD.
- In-hospital mortality was compared using unadjusted and adjusted odds ratios.
Main Results:
- VHD was attributed as the cause in 4.1% of CS admissions, with mitral regurgitation and aortic stenosis being most common.
- CS attributed to VHD showed higher rates of preserved left ventricular ejection fraction (LVEF ≥ 40%) on admission (62.8%).
- In-hospital mortality was 40.0% for CS attributed to VHD, versus 33.4% and 30.3% in other groups.
Conclusions:
- Valvular heart disease is an underlying cause in a minority of CS admissions but is associated with elevated in-hospital mortality.
- These findings highlight the critical impact of VHD on CS outcomes in the CICU setting.
Background:
Cardiogenic shock (CS) can be complicated by severe valvular heart disease (VHD). We analyzed cardiac intensive care unit (CICU) admissions according to VHD status.
Methods And Results:
The Critical Care Cardiology Trials Network is a multicenter network of tertiary CICUs. Centers contributed data from consecutive admissions during 2-month annual snapshots from 2017-2023. CS admissions were classified as having CS attributed to VHD, CS with noncausative VHD or CS without severe VHD. Demographics and therapies were compared. Unadjusted and adjusted odds ratios for in-hospital mortality were calculated. We analyzed 5242 admissions with CS (4.1% attributed to VHD, 18.8% with noncausative VHD, 77.1% without severe VHD). Mitral regurgitation (32.1%) and aortic stenosis (27.9%) were the most common pathologies in CS attributed to VHD. Admissions with CS attributed to VHD more commonly had LVEF ≥ 40% on admission (present in 62.8%, 22.6% and 15.1%, respectively; P < 0.001). Valve intervention was performed in 32.1% of those with CS attributed to VHD. Unadjusted in-hospital mortality in admissions with CS attributed to VHD was 40.0%, compared to 33.4% and 30.3% in the other groups.
Conclusions:
VHD is the underlying cause of CS in a minority of CICU admissions but is associated with high in-hospital mortality rates.
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