SPC365

Prevalence and Predictors of Normotensive Cardiogenic Shock in Intermediate-High Risk Pulmonary Embolism

Session: Sessão de Posters 02 - Embolia Pulmonar
Speaker: Bárbara Lacerda Teixeira

Congress: CPC 2024
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme: 21.4 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Treatment
Session Type: Cartazes
FP Number: ---
Authors: Bárbara Lacerda Teixeira; Sofia Jacinto; Miguel Antunes; André Grazina; Francisco Albuquerque; André Ferreira; Joao Reis; Ana Galrinho; Luis Almeida Morais; Ruben Ramos; Duarte Cacela; Rui Cruz Ferreira

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Patients diagnosed with acute pulmonary embolism (PE) and hypotension (high-risk PE)&nbsp;exhibit a notably elevated mortality rate. In&nbsp;intermediate-risk PE, cardiogenic shock may also manifest, but this subgroup is less extensively characterized. Patients with normotensive shock (NTS) display systolic blood pressure &ge; 90 mmHg but cardiac index &le; 2.2 L/min/m2, and it is generally recognized that these patients may still face significant morbidity and mortality due to compromised cardiac function and inadequate perfusion to vital organs.</span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Objectives</strong></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">To assess prevalence and predictors of NTS in intermediate-risk PE</span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">A prospective registry of consecutive intermediate-high PE pts submitted to catheter directed therapies (CDT) in a single tertiary center was used.&nbsp;Clinical, biomarkers, echocardiographic, CT&nbsp;and right heart catheterization (RHC) data were collected at admission. Pts were divided according to having NTS or not. Comparison was assessed by chi-square, t-test and Mann-Whitney. Logistic regression was used to identify predictors of NTS. After the identification of this variables, a composite score was made and assessed for its accuracy to identify NTS patients using ROC curve analysis.</span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">48 pts (45,8% women, mean age 57 &plusmn; 18) were included. 27,1% (n=13) were in NTS. Patients in&nbsp;NTS were more likely to have acute-on-chronic presentation (38,5% vs 8,6%, p = 0,014), higher lactate levels (1,7&nbsp;vs 1,1, p = 0,011), lower venous saturation of oxygen (SvO2) (57 &plusmn; 7,7 vs 67 &plusmn; 6,8, p &lt; 0,001), have saddle PE (53,8% vs 22,9%, p = 0,040), RV dysfunction on echocardiography (84,6% vs 52,9%, p = 0,046), higher NT-proBNP levels (3667 vs 1991, p = 0,036) and higher creatinine levels (1,4 vs 0,8, p = 0,010). A&nbsp;double approach in CDT&nbsp;(fibrinolysis + penumbra)&nbsp;was more common in patients with NTS&nbsp;(38,5% vs 5,7%, p = 0,014). Regarding NTS predictors, we identified 5 independent predictors: acute-on-chronic presentation (p = 0,005), lactate levels (p = 0,034), SvO2 (p = 0,013), saddle PE (p &lt; 0,001) and creatinine levels (p = 0,017). Using a ROC curve analysis, AUC for lactate was 0.740 with a Sn of 61,5% and a Sp 66% for a cut-off of 1,55, for SvO2 was 0.836 with a Sn of 76,9% and Sp 82% for a cut-off of 61,9%, for creatinine was 0.745 with a Sn of 61,5% and Sp 80% for a cut-off of 1,1 mg/dL. After identify these cut-offs, a composite score was created, attributing 1 point for each predictor. A score &ge; 3 (from 0 to 5) demonstrated high accuracy to identify NTS patients, with an AUC 0,909, p &lt; 0,001, a Sn 85% and Sp of 99%.</span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusions</strong></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Despite being hemodynamically stable, 27% of patients classified as intermediate-high risk exhibited normotensive shock. Our findings indicate that acute-on-chronic presentation, lactate levels, SvO2, the presence of saddle pulmonary embolism, and creatinine levels were independent predictors of this condition. A score 3 &ge; effectively enhanced the risk stratification of these patients.</span></span></span></p>