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Multicenter Study
. 2023 Oct 25;12(10):651-660.
doi: 10.1093/ehjacc/zuad095.

Prognostic significance of haemodynamic parameters in patients with cardiogenic shock

David D Berg  1 , Gurleen Kaur  2 , Erin A Bohula  1 , Vivian M Baird-Zars  1 , Carlos L Alviar  3 , Christopher F Barnett  4 , Gregory W Barsness  5 , James A Burke  6 , Sunit-Preet Chaudhry  7 , Meshe Chonde  8 , Howard A Cooper  9 , Lori B Daniels  10 , Mark W Dodson  11 , Daniel A Gerber  12 , Shahab Ghafghazi  13 , Umesh K Gidwani  14 , Michael J Goldfarb  15 , Jianping Guo  1 , Dustin Hillerson  16 , Benjamin B Kenigsberg  17 , Ajar Kochar  1 , Michael C Kontos  18 , Younghoon Kwon  19 , Mathew S Lopes  1 , Daniel B Loriaux  20 , P Elliott Miller  21 , Connor G O'Brien  4 , Alexander I Papolos  17 , Siddharth M Patel  1 , Barbara A Pisani  22 , Brian J Potter  23 , Rajnish Prasad  24 , Robert O Rowsell  25 , Kevin S Shah  26 , Shashank S Sinha  27 , Timothy D Smith  28 , Michael A Solomon  29 , Jeffrey J Teuteberg  12 , Andrea D Thompson  30 , Sammy Zakaria  31 , Jason N Katz  20 , Sean van Diepen  32 , David A Morrow  1
Affiliations
Multicenter Study

Prognostic significance of haemodynamic parameters in patients with cardiogenic shock

David D Berg et al. Eur Heart J Acute Cardiovasc Care. .

Erratum in

Abstract

Aims: Invasive haemodynamic assessment with a pulmonary artery catheter is often used to guide the management of patients with cardiogenic shock (CS) and may provide important prognostic information. We aimed to assess prognostic associations and relationships to end-organ dysfunction of presenting haemodynamic parameters in CS.

Methods and results: The Critical Care Cardiology Trials Network is an investigator-initiated multicenter registry of cardiac intensive care units (CICUs) in North America coordinated by the TIMI Study Group. Patients with CS (2018-2022) who underwent invasive haemodynamic assessment within 24 h of CICU admission were included. Associations of haemodynamic parameters with in-hospital mortality were assessed using logistic regression, and associations with presenting serum lactate were assessed using least squares means regression. Sensitivity analyses were performed excluding patients on temporary mechanical circulatory support and adjusted for vasoactive-inotropic score. Among the 3603 admissions with CS, 1473 had haemodynamic data collected within 24 h of CICU admission. The median cardiac index was 1.9 (25th-75th percentile, 1.6-2.4) L/min/m2 and mean arterial pressure (MAP) was 74 (66-86) mmHg. Parameters associated with mortality included low MAP, low systolic blood pressure, low systemic vascular resistance, elevated right atrial pressure (RAP), elevated RAP/pulmonary capillary wedge pressure ratio, and low pulmonary artery pulsatility index. These associations were generally consistent when controlling for the intensity of background pharmacologic and mechanical haemodynamic support. These parameters were also associated with higher presenting serum lactate.

Conclusion: In a contemporary CS population, presenting haemodynamic parameters reflecting decreased systemic arterial tone and right ventricular dysfunction are associated with adverse outcomes and systemic hypoperfusion.

Keywords: Cardiogenic shock; Haemodynamics; Outcomes; Pulmonary artery catheter.

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Conflict of interest statement

Conflict of interest: D.D.B., E.A.B., V.M.B-Z., J.G., S.M.P., and D.A.M. are members of the TIMI Study Group, which has received institutional research grant support through Brigham and Women’s Hospital from Abbott, Abiomed, Amgen, Anthos Therapeutics, ARCA Biopharma, Inc., AstraZeneca, Bayer HealthCare Pharmaceuticals, Inc., Daiichi-Sankyo, Eisai, Intarcia, Ionis Pharmaceuticals, Inc., Janssen Research and Development, LLC, MedImmune, Merck, Novartis, Pfizer, Quark Pharmaceuticals, Regeneron Pharmaceuticals, Inc., Roche, Siemens Healthcare Diagnostics, Inc., Softcell Medical Limited, The Medicines Company, Zora Biosciences. M.A.S. receives research support from the National Institutes of Health Clinical Center intramural research funds. A.D.T. is supported by NIH-NHLBI (K08HL163328).

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Strength of univariable associations between presenting haemodynamic parameters and in-hospital mortality. Haemodynamic parameters are ordered according to strength of association with in-hospital mortality based on Wald χ2 values from univariable logistic regression models. Haemodynamic indices significantly associated with in-hospital mortality and reflecting either decreased systemic arterial tone or impaired right ventricular function are highlighted in colour. Analyses are restricted to patients with complete haemodynamic data (n = 1132). CI, cardiac index; CPO, cardiac power output; DPG, diastolic pressure gradient; HR, heart rate; MAP, mean arterial pressure; PAC, pulmonary artery compliance; PADP, pulmonary artery diastolic pressure; PAE, pulmonary artery elastance; PAPI, pulmonary artery pulsatility index; PASP, pulmonary artery systolic pressure; PCWP, pulmonary capillary wedge pressure; PVR, pulmonary vascular resistance; RAP, right atrial pressure; SBP, systolic blood pressure; SVR, systemic vascular resistance; TPG, transpulmonary gradient.
Figure 2
Figure 2
Adjusted associations between haemodynamic parameters and in-hospital mortality accounting for background haemodynamic support. Associations with in-hospital mortality are shown: unadjusted (Model 1); adjusted for vasoactive-inotropic score (VIS) (Model 2); excluding patients with MCS at the time of invasive haemodynamic assessment and adjusting for VIS (Model 3); and excluding patients with MCS at the time of invasive haemodynamic assessment and adjusting for VIS, age, sex, SCAI stage, and preceding cardiac arrest (Model 4). VIS was not collected in earlier annual cycles of the registry, so the VIS-adjusted analyses exclude approximately 22% of patients from the primary analysis cohort. Approximately 25% of patients in the primary analysis cohort were receiving mechanical circulatory support at the time of haemodynamic assessment. MCS, mechanical circulatory support; OR, odds ratio; SD, standard deviation; VIS, vasoactive-inotropic score.
Figure 3
Figure 3
Strength of univariable associations between presenting haemodynamic parameters and presenting serum lactate. Haemodynamic parameters are ordered according to strength of association with serum lactate based on the absolute value of the t statistic in the univariable least squares means regression models. Haemodynamic indices significantly associated with presenting serum lactate and reflecting either decreased systemic arterial tone or impaired right ventricular function are highlighted in colour. Analyses are restricted to patients with complete haemodynamic data (n = 1132). CI, cardiac index; CPO, cardiac power output; DPG, diastolic pressure gradient; HR, heart rate; MAP, mean arterial pressure; PAC, pulmonary artery compliance; PADP, pulmonary artery diastolic pressure; PAE, pulmonary artery elastance; PAPI, pulmonary artery pulsatility index; PASP, pulmonary artery systolic pressure; PCWP, pulmonary capillary wedge pressure; PVR, pulmonary vascular resistance; RAP, right atrial pressure; SBP, systolic blood pressure; SVR, systemic vascular resistance; TPG, transpulmonary gradient.
Figure 4
Figure 4
Association of haemodynamic parameters with in-hospital mortality in patients with acute myocardial infarction-related cardiogenic shock vs. decompensated heart failure-related cardiogenic shock. Analyses are restricted to patients with complete haemodynamic data (n = 1132). CI, cardiac index; CPO, cardiac power output; MAP, mean arterial pressure; PAPI, pulmonary artery pulsatility index; PCWP, pulmonary capillary wedge pressure; RAP, right atrial pressure; SBP, systolic blood pressure; SVR, systemic vascular resistance.
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