Predictors of Progression to Low Cardiac Output or Cardiogenic Shock in Patients Hospitalized for Acute Heart Failure

During hospitalization, patients with acute heart failure (AHF) may progress to low cardiac output syndrome (LCOS) or cardiogenic shock (CS). However, the predictive factors for this evolution are not clearly defined. To evaluate the frequency of progression to LCOS or CS in patients hospitalized for AHF and to identify predictive factors of this progression among clinical, echocardiographic, and laboratory parameters obtained at admission. A single-center cohort study was conducted, performing a retrospective analysis of prospectively collected data from consecutive patients admitted for AHF between 2015 and 2020. The primary endpoint was the occurrence of LCOS or SCAI (Society for Cardiovascular Angiography and Interventions) stage C to E CS during the index hospitalization. Logistic regression models adjusted for age and sex were used to determine the association between predictive factors and the occurrence of the primary endpoint. A total of 748 patients were included, with a mean age of 76 ± 11.7 years, 63.6% of whom were men. Coronary artery disease accounted for 34.5% of the etiology of heart failure (HF), and 36.9% of the patients had a previous hospitalization for HF. The median left ventricular ejection fraction (LVEF) was 46% (interquartile range 41, 60), and reduced LVEF <40% accounted for 40.5% of cases. The primary endpoint occurred in 22.33% of the cohort (n = 167). In-hospital mortality was 38.9% in patients who developed LCOS or CS, compared to 4.5% in those who did not (p < 0.001). Systolic blood pressure at admission for every 10 mmHg decrease (odds ratio [OR] 1.25, 95% confidence intervals [CI] 1.12-1.40, p < 0.001), estimated creatinine clearance <60 ml/min/m² (OR 1.99, 95% CI 1.27-3.13, p = 0.003), LVEF <40% (OR 1.65, 95% CI 1.11-2.45, p = 0.013), and TAPSE (tricuspid annular plane systolic excursion) <18 mm (OR 2.05, 95% CI 1.39-3.02, p < 0.001) were significant predictors of progression to LCOS or CS. In a cohort of patients hospitalized for AHF, systolic blood pressure, estimated creatinine clearance <60 ml/min/m², LVEF <40%, and TAPSE <18 mm were identified as predictive factors for progression to CS or LCOS. These simple, widely available parameters obtained at the time of admission may allow for early identification of at-risk patients and could impact management and treatment strategies. However, additional prospective studies are needed to validate these findings and confirm their clinical utility in routine practice.