Journal article
Association of Hemometabolic Trajectory and Mortality: Insights From the Cardiogenic Shock Working Group Registry
Journal of cardiac failure, v 30(10), pp 1196-1207
Oct 2024
PMID: 39389726
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Cardiogenic shock (CS) is a hemodynamic syndrome that can progress to systemic metabolic derangements and end-organ dysfunction. Prior studies have reported hemodynamic parameters at the time of admission to be associated with mortality but hemodynamic trajectories in CS have not been well described. We studied the association between hemodynamic profiles and their trajectories and in-hospital mortality in patients with CS due to heart failure (HF-CS) and acute myocardial infarction (MI-CS). Using data from the large multicenter Cardiogenic Shock Working Group (CSWG) registry, we analyzed hemodynamic data obtained at the time of pulmonary artery catheter (PAC) insertion (dataset at baseline) and at PAC removal or death (dataset at final time point). Univariable regression analyses for prediction of in-hospital mortality were conducted for baseline and final hemodynamic values, as well as the interval change (delta-P). Data was further analyzed based on CS etiology and survival status. A total of 2260 patients with PAC data were included (70% male, age 61 ± 14 years, 61% HF-CS, 27% MI-CS). In-hospital mortality was higher in the MI-CS group (40.1%) compared with HF-CS (22.4%, P < .01). In the HF-CS cohort, survivors exhibited lower right atrial pressure (RAP), pulmonary artery pressure (PAP), cardiac output/index (CO/CI), lactate, and higher blood pressure (BP) than nonsurvivors at baseline. In this cohort, during hospitalization, improvement in metabolic (aspartate transaminase, lactate), BP, hemodynamic (RAP, pulmonary artery pulsatility index [PAPi], pulmonary artery compliance for right-sided profile and CO/CI for left-sided profile), had association with survival. In the MI-CS cohort, a lower systolic BP and higher PAP at baseline were associated with odds of death. Improvement in metabolic (lactate), BP, hemodynamic (RAP, PAPi for right-sided profile and CO/CI for left-sided profile) were associated with survival. In a large contemporary CS registry, hemodynamic trajectories had a strong association with short-term outcomes in both cohorts. These findings suggest the clinical importance of timing and monitoring hemodynamic trajectories to tailor management in patients with CS.
•Baseline hemodynamics impact mortality in HF-CS more so than MI-CS.•Hemodynamics indicative of end-organ perfusion and congestion have distinct trajectories between survivors and non-survivors in CS.•Hemodynamic trajectories have strong association with hospital outcomes in both HF- and MI-CS•Changes in hemodynamics should be closely monitored to tailor management practices in CS
Metrics
Details
- Title
- Association of Hemometabolic Trajectory and Mortality: Insights From the Cardiogenic Shock Working Group Registry
- Creators
- WISSAM Khalife - The University of Texas Medical Branch at GalvestonMANREET K. Kanwar - Allegheny Health NetworkJACOB Abraham - Hope Heart InstituteSONG LI - Medical City Dallas HospitalKEVIN John - Tufts Medical CenterSHASHANK S. Sinha - Inova Fairfax HospitalELRIC Zweck - Heinrich Heine University DüsseldorfBORUI LI - Tufts Medical CenterARTHUR R. Garan - Beth Israel Deaconess Medical CenterJAIME HERNANDEZ-MONTFORT - Baylor Scott & White HealthYIJING Zhang - Tufts Medical CenterVAN-KHUE Ton - Massachusetts General HospitalMAYA Guglin - Health Advanced Heart and Lung Care, Indianapolis, IndianaRACHNA Kataria - LifespanGAVIN W. Hickey - University of Pittsburgh Medical CenterSARASCHANDRA Vallabhajosyula - Health Advanced Heart and Lung Care, Indianapolis, IndianaCHLOE Kong - Medical City Dallas HospitalMARYJANE Farr - The University of Texas Southwestern Medical CenterJUSTIN Fried - Columbia University Irving Medical CenterSHELLEY Hall - Baylor Scott & White HealthNEIL M. Harwani - Tufts Medical CenterCLAUDIUS Mahr - Medical City Dallas HospitalSANDEEP Nathan - University of ChicagoPAAVNI Sangal - Tufts Medical CenterANDREW Schwartzman - Maine Medical CenterARVIND Bhimaraj - Houston MethodistJ U Kim - Houston MethodistALEC A. Vishnevsky - Thomas Jefferson University HospitalESTHER Vorovich - Northwestern MedicineKAROL D. Walec - Tufts Medical CenterPETER Zazzali - Tufts Medical CenterAIHAM Albaeni - The University of Texas Medical Branch at GalvestonDANIEL Burkhoff - Cardiovascular Research FoundationNAVIN K. Kapur - Tufts Medical Center
- Publication Details
- Journal of cardiac failure, v 30(10), pp 1196-1207
- Publisher
- Elsevier; PHILADELPHIA
- Number of pages
- 12
- Grant note
- Abiomed Inc.LivaNova Inc.Boston Scientific IncAbbott LaboratoriesGetinge Inc.
This work was supported by institutional grants from Abiomed Inc., Boston Scientific Inc,. Abbott Laboratories, Getinge Inc., and LivaNova Inc. to Tufts Medical Center. The sponsors had no input on collection, analysis, and interpretation of the data, nor in the preparation, review, or approval of the manuscript.
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Cardiology
- Web of Science ID
- WOS:001343290900001
- Scopus ID
- 2-s2.0-85204986994
- Other Identifier
- 991021932186304721
UN Sustainable Development Goals (SDGs)
This publication has contributed to the advancement of the following goals:
InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems