Dynamic assessment of left ventricular coupling and myocardial reserve in patients with cardiogenic shock.

European heart journal open Pub Date : 2024-08-26 eCollection Date: 2024-09-01 DOI:10.1093/ehjopen/oeae072
Anthony J Kanelidis, Michael J Randazzo, Sara Kalantari, Bryan Smith, Ann Nguyen, Ben B Chung, Stanley Swat, Nitasha Sarswat, Christopher Salerno, Valluvan Jeevanandam, Gene Kim, Mark N Belkin, Jonathan Grinstein
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Abstract

Aims: Pulmonary artery catheter haemodynamics are associated with improved survival in cardiogenic shock (CS). We investigated the utility of aortic pulsatility index (API) and cardiac power output (CPO) as surrogates for left ventricular (LV) coupling and myocardial reserve, respectively, in patients with CS undergoing dynamic assessment after a milrinone bolus.

Methods and results: Patients with SCAI Stage C CS underwent a milrinone drug study (50 mcg/kg bolus infused over 10 min) to assess inotropic response. Haemodynamic measurements were obtained at baseline and following the bolus. Aortic pulsatility index and CPO were used to risk-stratify patients with the incidence of LV assist device (LVAD), orthotopic heart transplantation (OHT), or death at 1 year as the primary composite endpoint. Two hundred and twenty-four patients in SCAI Stage C CS underwent haemodynamics prior to milrinone bolus, and 117 patients had low baseline API < 1.45. Of the 117 patients, 88 had a final API < 2.2 after milrinone load, consistent with LV decoupling, in which 73% met the composite endpoint. The remaining 29 patients had a final API ≥ 2.2 consistent with LV recoupling, and only 55% met the composite endpoint (P = 0.046). Of the 117 patients, 40 patients had low myocardial reserve (final CPO < 0.77 W), in which 78% met the composite endpoint. Of the 77 patients who demonstrated myocardial reserve (final CPO ≥ 0.77 W), only 64% met the composite endpoint (P = 0.039).

Conclusion: The use of API and CPO in a dynamic assessment after provocative testing led to improved risk stratification in patients with SCAI Stage C CS for clinical outcomes including LVAD, OHT, or death at 1 year.

动态评估心源性休克患者的左心室耦联和心肌储备。
目的:肺动脉导管血流动力学与改善心源性休克(CS)患者的存活率有关。我们研究了主动脉搏动指数(API)和心脏动力输出(CPO)分别作为左心室(LV)耦合和心肌储备的替代指标,在米力农注射后接受动态评估的 CS 患者中的实用性:SCAI C 期 CS 患者接受米力农药物研究(50 mcg/kg 栓注,10 分钟内输注),以评估肌力反应。血流动力学测量在基线和栓注后进行。主动脉搏动指数和CPO用于对患者进行风险分级,以左心室辅助装置(LVAD)、正位心脏移植(OHT)或1年内死亡的发生率作为主要的复合终点。224 名 SCAI C 期 CS 患者在注射米力农之前接受了血流动力学检查,其中 117 名患者的基线 API 低于 1.45。在这 117 名患者中,88 名患者在米力农负荷后的最终 API < 2.2,符合左心室解耦,其中 73% 的患者达到了复合终点。其余29名患者的最终API≥2.2,符合左心室再耦合,只有55%的患者达到了综合终点(P = 0.046)。在 117 名患者中,40 名患者的心肌储备较低(最终 CPO < 0.77 W),其中 78% 的患者达到了综合终点。在 77 名显示心肌储备(最终 CPO ≥ 0.77 W)的患者中,只有 64% 达到了综合终点(P = 0.039):结论:在诱导性测试后使用 API 和 CPO 进行动态评估,可改善 SCAI C 期 CS 患者的风险分层,改善其 1 年后的临床预后,包括 LVAD、OHT 或死亡。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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