Phase-Specific Hemodynamic Criteria and Outcomes in Patients With Cardiogenic Shock Receiving Percutaneous Ventricular Assist Devices.

IF 5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Heart Association Pub Date : 2025-06-18 DOI:10.1161/JAHA.125.042249

Yuki Ikeda, Keita Saku, Jun Nakata, Takashi Unoki, Takeshi Yamamoto, Tomohiro Sakamoto, Junya Ako

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引用次数: 0

Abstract

Background: Standardized protocols with optimal hemodynamic targets for percutaneous ventricular assist device (PVAD) management remain undefined. We aimed to evaluate the proportion of phase-specific hemodynamic criteria achieved during PVAD support and their association with outcomes in patients with cardiogenic shock.

Methods: This multicenter retrospective study enrolled patients with cardiogenic shock requiring PVAD (Impella). Patients were evaluated at 24 hours post-PVAD, venoarterial extracorporeal membrane oxygenation weaning, and PVAD weaning. Hemodynamic criteria consisted of key targets, including mean arterial pressure ≥60 mm Hg, lactate <2.0 mmol/L, right atrial pressure <15 mm Hg, pulmonary artery wedge pressure <20 mm Hg, pulmonary artery pulsatility index ≥1.0, and cardiac power output ≥0.6 W. The primary outcome was a composite of 30-day all-cause mortality and unplanned mechanical circulatory support reintroduction.

Results: A total of 501 patients were enrolled: 206 (41%) with PVAD alone and 295 (59%) with PVAD and venoarterial extracorporeal membrane oxygenation. The majority of patients were supported with Impella CP (406, 81%). Fulfillment of criteria was observed in 37%, 52%, and 45% at 24 hours post-PVAD, venoarterial extracorporeal membrane oxygenation weaning, and PVAD weaning, respectively. Patients with unfulfilled criteria at each evaluation point were at high risk for the primary outcome (hazard ratio, 3.2 [95% CI, 2.1-4.8]; hazard ratio, 2.1 [1.2-3.7]; and hazard ratio, 2.0 [95% CI, 1.1-3.6]). Hemodynamic criteria achievement consistently stratified the risk of the primary outcome across different subgroups, including shock cause, shock stage, and concomitant use of venoarterial extracorporeal membrane oxygenation.

Conclusions: Phase-specific hemodynamic criteria are often unmet and are associated with significantly higher risks of short-term fatal events.

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接受经皮心室辅助装置的心源性休克患者的阶段特异性血流动力学标准和结果。

背景：经皮心室辅助装置（PVAD）管理的最佳血流动力学目标的标准化方案仍未明确。我们的目的是评估在PVAD支持期间达到的阶段特异性血流动力学标准的比例及其与心源性休克患者预后的关系。方法：这项多中心回顾性研究纳入了需要PVAD （Impella）的心源性休克患者。在PVAD、静脉动脉体外膜氧合脱机和PVAD脱机后24小时对患者进行评估。血流动力学标准包括主要指标，包括平均动脉压≥60 mm Hg，乳酸水平。结果：共入组501例患者：单独PVAD 206例（41%），PVAD合并静脉外膜氧合295例（59%）。大多数患者支持Impella CP（406, 81%）。在PVAD、静脉动脉体外膜氧合脱机和PVAD脱机后24小时，分别有37%、52%和45%的患者符合标准。在每个评价点均未达到标准的患者的主要结局风险较高(风险比为3.2 [95% CI, 2.1-4.8]；风险比，2.1 [1.2-3.7]；风险比为2.0 [95% CI, 1.1-3.6])。血液动力学标准的实现一致地将不同亚组的主要结局风险分层，包括休克原因、休克阶段和同时使用静脉体外膜氧合。结论：阶段特异性血流动力学标准经常不符合，并且与短期致命事件的风险显着升高相关。

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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来源期刊

Journal of the American Heart Association CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

9.40

自引率

1.90%

发文量

1749

审稿时长

12 weeks

期刊介绍： As an Open Access journal, JAHA - Journal of the American Heart Association is rapidly and freely available, accelerating the translation of strong science into effective practice. JAHA is an authoritative, peer-reviewed Open Access journal focusing on cardiovascular and cerebrovascular disease. JAHA provides a global forum for basic and clinical research and timely reviews on cardiovascular disease and stroke. As an Open Access journal, its content is free on publication to read, download, and share, accelerating the translation of strong science into effective practice.