Related Experiment Video
Updated: May 15, 2025
The Intra-Aortic Balloon Pump
Published on: February 5, 2021
Diastolic Perfusion Pressure Predicts Response to Inotropes and Vasopressors and Benefit From Mechanical Circulatory
Hoong Sern Lim1,2, Dagmar Vondrakova3, Jan Belohlavek4
1Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, United Kingdom (H.S.L.).
Background:
Hemodynamic response to escalation of vasoactive drugs has not been well-characterized in patients with cardiogenic shock (CS). We tested the hypothesis that lower diastolic perfusion pressure (DPP=diastolic blood pressure-right atrial pressure) was associated with more limited hemodynamic response to uptitration of vasoactive drugs and with possible benefit from early mechanical circulatory support in patients with CS.
Methods:
This study consisted of 2 parts: (1) we evaluated the relationship between baseline DPP and changes in cardiac power output index (CPOI) in response to increase in vasoactive drugs in a cohort of patients with CS (n=93) and (2) we compared all-cause mortality based on baseline DPP in a post hoc analysis of the ECMO-CS trial (Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock). CPOI responders were defined as postescalation CPOI ≥0.28 W/m2.
Results:
Vasoactive inotrope score escalated from 11.2±3.9 to 24.5±4.7. Escalation of vasoactive drugs was associated with increases in CPOI to 0.23±0.06 W/m2 (all P<0.001). Postescalation CPOI was directly related to baseline cardiac index and DPP. Baseline DPP discriminated cardiac power output responders from nonresponders with an optimal cutoff of 37 mm Hg. Patients with baseline DPP ≥37 mm Hg had greater CPOI increase and lactate clearance. In the ECMO-CS trial, patients with DPP <37 mm Hg had lower mortality (hazard ratio, 0.37 [95% CI, 0.14-0.97]; P=0.044) with immediate venoarterial extracorporeal membrane oxygenation compared with early conservative management but no significant difference in the subgroup with DPP ≥37 mm Hg.
Conclusions:
Lower DPP was associated with more limited hemodynamic response to escalation of vasoactive drugs and potentially greater benefit from early venoarterial extracorporeal membrane oxygenation in CS.
More Related Videos
06:10Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
07:39Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
Published on: August 16, 2021
Related Concept Videos
01:29Pathophysiology of Cardiac Performance
01:24Blood Pressure
01:22Heart Failure Drugs: β-Blockers
01:22Cardiac Output II: Effect of Stroke Volume on Cardiac Output
Preload
Preload refers to the initial elongation of the cardiac myocytes before contraction and is related to the volume of blood filling the heart at the end of diastole, or end-diastolic volume. The...
01:24Blood Pressure Imbalances and Circulatory Shock
Blood Pressure: Hypertension and Hypotension
Normal blood pressure is 120/80 mm Hg. Elevated blood pressure is 120-129/under 80 mm Hg. Hypertension, warranting treatment at 130/80 mm Hg, is often asymptomatic and can lead to severe cardiovascular events, aneurysms, peripheral arterial disease, chronic renal disease, or cardiac...
01:27Regulation of Stroke Volume
Preload refers to the degree of stretch on the heart before it contracts. It's analogous to the stretching of a rubber band; the more it's stretched, the more forcefully it snaps back. This concept is encapsulated in the Frank-Starling...