SPC365

Circulatory Power – a newly developed non-invasive dynamic parameter to predict in-hospital mortality in Cardiogenic Shock

Session: Comunicações Orais - Sessão 04 - Choque cardiogénico
Speaker: João Presume

Congress: CPC 2023
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 14. Acute Cardiac Care
Subtheme: 14.4 Acute Cardiac Care – Cardiogenic Shock
Session Type: Comunicações Orais
FP Number: ---
Authors: João Presume; Ana Rita Bello; Daniel Gomes; Catarina Brízido; Christopher Strong; António Tralhão; Jorge Ferreira

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Introduction</u></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Prognosis estimation is essential for tailored treatment in patients admitted due to cardiogenic shock (CS). Cardiac Power Output is the strongest independent hemodynamic correlate to predict in-hospital mortality in patients with CS but needs invasive pulmonary artery catheterization. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">We sought to develop an alternative non-invasive dynamic variable (Circulatory Power [CP]) including the reciprocal of serum lactate measurement as a surrogate of cardiac output, and evaluate its performance in predicting in-hospital mortality in patients admitted for CS. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Methods:</u></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Patients admitted to a cardiac ICU due to CS of any cause from 2017 to 2022 were retrospectively identified. Those without serum lactate at admission were excluded. CP was defined as the ratio between mean arterial pressure and serum lactate, collected at admission. To derive and validate this marker, patients were randomized in a 2:1 fashion into two cohorts, respectively.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Results</u></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">We analyzed a total of 144 patients (67&plusmn;16 years, 68% male, 53% with acute myocardial infarction). At admission, 79% of patients were in SCAI stage C, the median LVEF was 27% [20; 35], the median CP was 21 [12;34] and the median serum lactate was 3.3 [2.0;5.9] mmol/L. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Both CP (35&plusmn;27 vs. 20&plusmn;20; OR 0.966 [0.946; 0.986]; p=0.001) and serum lactate (3.3&plusmn;2.3 vs. 5.4&plusmn;3.9; OR 1.275 [1.113; 1.459]; p&lt;0.001) showed a statistically significant association with in-hospital mortality. Furthermore, both markers showed good discriminative power to predict in-hospital mortality, with CP being significantly superior (AUC 0.738 vs. AUC 0.695; p=0.005). </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Patients were then randomized to derivation (n=96) and validation cohorts (n=48). In the derivation cohort, CP was associated with increased in-hospital mortality (p=0.019) and good discriminative power (AUC 0.742; p&lt;0.001), maintaining superiority over isolated serum lactate (p=0.030). The best threshold to identify high mortality risk was 20 with a sensitivity of 70.2% and specificity of 70.0%. In the validation cohort, this cut-off was significantly associated with higher mortality (30.4% vs. 65.0% mortality &ndash; OR 4.245 [1.183; 15.236]; p=0.023) &ndash; figure 1.&nbsp; </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Conclusion</u></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Circulatory power is a newly developed non-invasive parameter that showed a strong association with in-hospital mortality in patients admitted due to cardiogenic shock, superior to isolated serum lactate. There was a 3.4% lower mortality for each unit increase in CP. The best cut-off for the identification of mortality risk was 20 units, which was associated with a 4x increase in the odds of in-hospital mortality in the validation cohort.</span></span></p>