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Diastolic Shock Index: A Novel Prognostic Parameter Unveiling Insights into Vasodilatory Cardiogenic Shock
Session:
Comunicações Orais - Sessão 14 - Choque cardiogénico e suporte circulatório mecânico
Speaker:
Mariana Sousa Paiva
Congress:
CPC 2024
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:
Mariana Sousa Paiva; Rita A. Carvalho; Catarina Brízido; Ana Rita Bello; Maria Rita Lima; Miguel Domingues; Joana Certo Pereira; Samuel Azevedo; João Presume; Christopher Strong; Jorge Ferreira; António Tralhão
Abstract
<p><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Introduction</strong>: Systemic vasodilation is an increasingly acknowledged feature in cardiogenic shock (CS), defining a subset of patients with low systemic vascular resistances and higher vasopressor requirements. While a diastolic shock index (DSI) above 2.0 predicts vasoplegia and mortality in septic shock, its cut-off and prognostic significance in CS remain unclear. Our study aimed to characterize vasoplegia in CS using the DSI and assess its impact on prognosis.</span></span></p> <p><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Methods</strong>: Single-center retrospective cohort study on Cardiac Intensive Care Unit (CICU) admissions for CS from January 2017 to October 2023. Data included patient variables, CS features, vasoactive drugs, mechanical circulatory support, and 30-day mortality. DSI (heart rate (HR) to invasive diastolic blood pressure (DBP) ratio) impact on 30-day all-cause mortality was assessed with univariate Cox regression. Optimal DSI cut-off for adverse outcomes was determined through ROC curve analysis, and survival based on this cut-off was analyzed using Kaplan-Meier curves.</span></span></p> <p><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Results</strong>: 185 patients (mean age 59 ± 12 years, 63% male) were included. Acute myocardial infarction-related CS (47%) and heart failure-related CS (29%) were predominant. According to SCAI classification, 86% were class C, 22% class D, and 4% class E, with 26% experiencing previous cardiac arrest. Median Vasoactive-Inotropic Score (VIS) was 48 (IQR 21-85), and 25% used mechanical circulatory support. At admission, median HR was 105 bpm (IQR 90-125), DBP was 60 mmHg (IQR 55-65), and DSI was 1.71 (IQR 1.31-2.18).</span></span></p> <p><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif">Thirty-day all-cause mortality was 36% (n=67), with median time to death of 4 days (IQR 1-10). DSI at 30 days predicted mortality (OR 1.42, 95%CI 1.06-1.91, p=0.020). DSI showed fair discriminative power for 30-day mortality (C-Statistic 0.60, 95% CI 0.51-0.68, p=0.031) with a cut-off of 2.2. Patients with DSI >2.2 exhibited heightened likelihood of prior cardiac arrest (38% vs. 20%, p=0.032), and higher serum lactate (5.5 vs. 3.9 mmol/L, p=0.008), and serum creatinine (2.64 vs. 1.88 mg/dL, p=0.003) at admission. Despite higher VIS at 48 hours (120±136 vs. 65±93.9, p=0.04), MCS need did not significantly differ. This group had superior 30-day mortality risk (log-rank p=0.011).</span></span></p> <p><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Conclusion</strong>: In our cohort, the admission Diastolic Shock Index (DSI) emerged as a promising identifier for CS vasoplegic patients and was a predictor of a higher risk for mortality. A DSI above 2.2 identified a subset of patients with previous cardiac arrest and higher lactate levels, enlightening possible risk factors associated with vasoplegia. Further studies are warranted to establish the robustness of this novel prognostic parameter in CS patients and its therapeutic implications.</span></span></p>
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