Title
Association of Hemometabolic Trajectory and Mortality: Insights From the Cardiogenic Shock Working Group Registry
Authors
Wissam Khalife1, Manreet K Kanwar 2, Jacob Abraham 3, Song Li 4, Kevin John 5, Shashank S Sinha 6, Elric Zweck 7, Borui Li 5, Arthur R Garan 8, Jaime Hernandez-Montfort 9, Yijing Zhang 5, VAN-Khue Ton 10, Maya Guglin 11, Rachna Kataria 12, Gavin W Hickey 13, Saraschandra Vallabhajosyula 11, Chloe Kong 4, Maryjane Farr 14, Justin Fried 15, Shelley Hall 16, Neil M Harwani 5, Claudius Mahr 4, Sandeep Nathan 17, Paavni Sangal 5, Andrew Schwartzman 18, Arvind Bhimaraj 19, J U Kim 19, Alec A Vishnevsky 20, Esther Vorovich 21, Karol D Walec 5, Peter Zazzali 5, Aiham Albaeni 1, Daniel Burkhoff 22, Navin K Kapur23
Journal
Journal of Cardiac Failure
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.