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The importance of congestion assessment by right heart catheterization in cardiogenic shock patients
Session:
Posters (Sessão 1 - Écran 6) - Cuidados Intensivos em Síndromes Coronárias Agudas
Speaker:
Ana Rita Bello
Congress:
CPC 2023
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Ana Rita Bello; João Presume; Daniel Gomes; Catarina Brízido; Christopher Strong; Jorge Ferreira; António Tralhão
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><u>Introduction:</u></strong><strong> </strong>Beyond the cardinal feature of low cardiac output, the presence of left and/or right-sided congestion may influence patient outcomes in the setting of cardiogenic shock. We aimed to describe the prevalence of different congestion profiles and their prognostic impact through invasive hemodynamic evaluation using the pulmonary artery catheter (PAC).</span></span></p> <p> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><u>Methods:</u></strong><strong> </strong>Single-center retrospective analysis of consecutively admitted patients to the cardiac intensive care unit (CICU) with cardiogenic shock of all etiologies, from January 2018 to November 2022, in whom a PAC was placed. Cardiogenic shock was defined by the presence of systolic blood pressure < 90 mmHg or vasopressor support, plus signs of clinical hypoperfusion and/or serum lactate ≥ 2mmol/L. The decision of pulmonary artery catheterization was left at clinician’s discretion. All patients required a cardiac index (CI) < 2.2 L/min/m<sup>2</sup> obtained by thermodilution. Right-sided or left-sided congestion were dichotomously (+/-) defined using central venous pressure (CVP) and pulmonary artery wedge pressure (PCWP) measurements, respectively. Four different congestion profiles [(A): CVP-/PCWP-, (B): CVP+/PCWP-, (C): CVP-/PCWP+, (D): CVP+/PCWP+)] were built based on the best cut-off for CVP and PCWP found by ROC curve analysis. Study endpoint was 30-day mortality. </span></span></p> <p> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><u>Results:</u></strong><strong> </strong>During the study period, 145 patients were admitted to the CICU with a diagnosis of cardiogenic shock, of whom 44 had a PAC inserted during their CICU stay showing low CI. Mean patient age was 58 ± 16 years and 71% were male. The main etiology of cardiogenic shock was acute myocardial infarction (n = 25). Mean left ventricular ejection fraction was 24 ± 11 %. 30-day mortality was 34% (n = 15). Mean CVP was 10 ± 5 mmHg and mean PCWP was 18 ± 8 mmHg. ROC curve analysis yielded 9 mmHg (CVP) and 16 mmHg (PCWP) as the most discriminative cut-offs for 30-day mortality. After hemodynamic congestion profiling, 19 patients were categorized as (A), 4 as (B), 4 as (C) and 17 as (D). 30-day mortality was 5.3%, 50.0%, 25.0% and 52.9%, respectively (p = 0.013, chi-square test).</span></span></p> <p> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><u>Conclusion:</u></strong><strong> </strong>In cardiogenic shock patients, individual congestion subsets were identified which translated into significantly different 30-day mortality. Pulmonary artery catheterization may contribute to better patient phenotyping and help devise targeted therapeutic strategies leading to improved outcomes.</span></span></p>
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