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Vasodilatory Cardiogenic Shock: Epidemiology, Invasive Phenotyping and Prognostic Implications.
Session:
Comunicações Orais - Sessão 01 - Choque cardiogénico e transplante cardíaco
Speaker:
Rita Almeida Carvalho
Congress:
CPC 2024
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.6 Acute Heart Failure - Clinical
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Rita Almeida Carvalho; Ana Rita Bello; Débora Silva Correia; Rita Barbosa Sousa; Samuel Azevedo; Maria Rita Lima; Mariana Sousa Paiva; João Presume; Catarina Brízido; Christopher Strong; Jorge Ferreira; António Tralhão
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background:</strong> Vasoplegia is an increasingly recognized feature of cardiogenic shock (CS). Its significance as either a different subtype of CS or the final stage of CS remains to be clarified. Furthermore, vasodilatory CS prevalence, characteristics, and outcomes remain unknown. </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The aim of this study was to invasively characterize CS-associated vasoplegia, its non-invasive predictors and its impact on patient prognosis. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> Retrospective single-center study including consecutive patients admitted to our Cardiac Intensive Care Unit (CICU), from January 2017 to October 2023, who underwent pulmonary artery catheter (PAC) insertion. The diagnosis of CS was based on the standard clinical definition. Clinical characteristics, laboratory and echocardiographic features, SCAI stage, and ongoing hemodynamic support were documented at the time of PAC insertion. The PAC was used to obtain a full hemodynamic evaluation, including cardiac output measurements (preferably by thermodilution). Patients were classified based on the calculated systemic vascular resistance (SVR) as having absence of vasoplegia (SVR >1200dynes*s/cm<sup>5</sup>), mild vasoplegia (SVR 800-1200dynes*s/cm<sup>5</sup>), or severe vasoplegia (SVR <800dynes*s/cm<sup>5</sup>). Population outcomes included CICU length-of-stay and 30-day all-cause mortality. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> From a total of 286 patients, 63 (21%) patients with CS and complete hemodynamic evaluation through PAC were included (mean age 61±17 years, 75% male). Among them, 46% presented with AMI-CS, and 75% in CS SCAI C. Vasoplegia was identified in 50% of patients, 21 (34%) were classified as having mild and 10 (26%) as having severe vasoplegia. Clinical, laboratory and baseline echocardiographic features were comparable between groups, although a numerically higher prevalence of AMI-CS (50 vs 45%) and SCAI D (25 vs 22%) patients was observed in the vasoplegic population. Vasoactive drug support was similar between both groups (median VIS 58 vs 52, p=0.769). No non-invasive predictors of an invasive vasoplegic profile were identified. Hemodynamic profiling showed vasoplegic patients had lower SVR but higher cardiac index (CI) (median SVR 761 vs 1268dynes*s/cm<sup>5</sup>, p<0.001; CI 2.74 vs 2.11L/min/m<sup>2</sup>, p=0.005), as well as lower pulmonary vascular resistance (PVR) and transpulmonary gradient (TPG) (median PVR 0.5 vs 3.3W, p<0.001; TPG 3 vs 11mmHg, p=0.011). The presence of vasoplegia did not significantly impact CICU length-of-stay (logrank p=0.867) or 30-day mortality (logrank p=0.079), even after adjusting SVR for the intensity of vasoactive drug support.<strong> </strong></span></span></p> <p><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"> The vasoplegic phenotype of CS was prevalent in our cohort. The invasive hemodynamic profile differs from the classic CS. Its presence did not, however, impact on CICU length-of-stay or 30-day mortality. These results suggest that vasodilatory CS might represent a different, but not necessarily more severe, patient subset.</span></span></p>
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