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Clinical Characteristics and Outcomes of Patients Suffering Acute Decompensated Heart Failure Complicated by Cardiogenic Shock.
Kyriakopoulos, Christos P; Sideris, Konstantinos; Taleb, Iosif; Maneta, Eleni; Hamouche, Rana; Tseliou, Eleni; Zhang, Chong; Presson, Angela P; Dranow, Elizabeth; Shah, Kevin S; Jones, Tara L; Fang, James C; Stehlik, Josef; Selzman, Craig H; Goodwin, Matthew L; Tonna, Joseph E; Hanff, Thomas C; Drakos, Stavros G.
Afiliación
  • Kyriakopoulos CP; Division of Cardiovascular Medicine, Department of Internal Medicine (C.P.K., K.S., I.T., E.M., R.H., E.T., E.D., K.S.S., T.L.J., J.C.F., J.S., T.C.H., S.G.D.), University of Utah Health and School of Medicine, Salt Lake City.
  • Sideris K; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City (C.P.K., I.T., E.M., R.H., E.T., C.H.S., S.G.D.).
  • Taleb I; Division of Cardiovascular Medicine, Department of Internal Medicine (C.P.K., K.S., I.T., E.M., R.H., E.T., E.D., K.S.S., T.L.J., J.C.F., J.S., T.C.H., S.G.D.), University of Utah Health and School of Medicine, Salt Lake City.
  • Maneta E; Division of Cardiovascular Medicine, Department of Internal Medicine (C.P.K., K.S., I.T., E.M., R.H., E.T., E.D., K.S.S., T.L.J., J.C.F., J.S., T.C.H., S.G.D.), University of Utah Health and School of Medicine, Salt Lake City.
  • Hamouche R; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City (C.P.K., I.T., E.M., R.H., E.T., C.H.S., S.G.D.).
  • Tseliou E; Division of Cardiovascular Medicine, Department of Internal Medicine (C.P.K., K.S., I.T., E.M., R.H., E.T., E.D., K.S.S., T.L.J., J.C.F., J.S., T.C.H., S.G.D.), University of Utah Health and School of Medicine, Salt Lake City.
  • Zhang C; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City (C.P.K., I.T., E.M., R.H., E.T., C.H.S., S.G.D.).
  • Presson AP; Division of Cardiovascular Medicine, Department of Internal Medicine (C.P.K., K.S., I.T., E.M., R.H., E.T., E.D., K.S.S., T.L.J., J.C.F., J.S., T.C.H., S.G.D.), University of Utah Health and School of Medicine, Salt Lake City.
  • Dranow E; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City (C.P.K., I.T., E.M., R.H., E.T., C.H.S., S.G.D.).
  • Shah KS; Division of Cardiovascular Medicine, Department of Internal Medicine (C.P.K., K.S., I.T., E.M., R.H., E.T., E.D., K.S.S., T.L.J., J.C.F., J.S., T.C.H., S.G.D.), University of Utah Health and School of Medicine, Salt Lake City.
  • Jones TL; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City (C.P.K., I.T., E.M., R.H., E.T., C.H.S., S.G.D.).
  • Fang JC; Division of Epidemiology, Department of Internal Medicine (C.Z., A.P.P.), University of Utah Health and School of Medicine, Salt Lake City.
  • Stehlik J; Division of Epidemiology, Department of Internal Medicine (C.Z., A.P.P.), University of Utah Health and School of Medicine, Salt Lake City.
  • Selzman CH; Division of Cardiovascular Medicine, Department of Internal Medicine (C.P.K., K.S., I.T., E.M., R.H., E.T., E.D., K.S.S., T.L.J., J.C.F., J.S., T.C.H., S.G.D.), University of Utah Health and School of Medicine, Salt Lake City.
  • Goodwin ML; Division of Cardiovascular Medicine, Department of Internal Medicine (C.P.K., K.S., I.T., E.M., R.H., E.T., E.D., K.S.S., T.L.J., J.C.F., J.S., T.C.H., S.G.D.), University of Utah Health and School of Medicine, Salt Lake City.
  • Tonna JE; Division of Cardiovascular Medicine, Department of Internal Medicine (C.P.K., K.S., I.T., E.M., R.H., E.T., E.D., K.S.S., T.L.J., J.C.F., J.S., T.C.H., S.G.D.), University of Utah Health and School of Medicine, Salt Lake City.
  • Hanff TC; Division of Cardiovascular Medicine, Department of Internal Medicine (C.P.K., K.S., I.T., E.M., R.H., E.T., E.D., K.S.S., T.L.J., J.C.F., J.S., T.C.H., S.G.D.), University of Utah Health and School of Medicine, Salt Lake City.
  • Drakos SG; Division of Cardiovascular Medicine, Department of Internal Medicine (C.P.K., K.S., I.T., E.M., R.H., E.T., E.D., K.S.S., T.L.J., J.C.F., J.S., T.C.H., S.G.D.), University of Utah Health and School of Medicine, Salt Lake City.
Circ Heart Fail ; 17(9): e011358, 2024 Sep.
Article en En | MEDLINE | ID: mdl-39206544
ABSTRACT

BACKGROUND:

Cardiogenic shock (CS) can stem from multiple causes and portends poor prognosis. Prior studies have focused on acute myocardial infarction-CS; however, acute decompensated heart failure (ADHF)-CS accounts for most cases. We studied patients suffering ADHF-CS to identify clinical factors, early in their trajectory, associated with a higher probability of successful outcomes.

METHODS:

Consecutive patients with CS were evaluated (N=1162). We studied patients who developed ADHF-CS at our hospital (N=562). Primary end point was native heart survival (NHS), defined as survival to discharge without receiving advanced HF therapies. Secondary end points were adverse events, survival, major cardiac interventions, and hospital readmissions within 1 year following index hospitalization discharge. Association of clinical data with NHS was analyzed using logistic regression.

RESULTS:

Overall, 357 (63.5%) patients achieved NHS, 165 (29.2%) died, and 41 (7.3%) were discharged post advanced HF therapies. Of 398 discharged patients (70.8%), 303 (53.9%) were alive at 1 year. Patients with NHS less commonly suffered cardiac arrest, underwent intubation or pulmonary artery catheter placement, or received temporary mechanical circulatory support, had better hemodynamic and echocardiographic profiles, and had a lower vasoactive-inotropic score at shock onset. Bleeding, hemorrhagic stroke, hemolysis in patients with mechanical circulatory support, and acute kidney injury requiring renal replacement therapy were less common compared with patients who died or received advanced HF therapies. After multivariable adjustments, clinical variables associated with NHS likelihood included younger age, history of systemic hypertension, absence of cardiac arrest or acute kidney injury requiring renal replacement therapy, lower pulmonary capillary wedge pressure and vasoactive-inotropic score, and higher tricuspid annular plane systolic excursion at shock onset (all P<0.05).

CONCLUSIONS:

By studying contemporary patients with ADHF-CS, we identified clinical factors that can inform clinical management and provide future research targets. Right ventricular function, renal function, pulmonary artery catheter placement, and type and timing of temporary mechanical circulatory support warrant further investigation to improve outcomes of this devastating condition.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Choque Cardiogénico / Insuficiencia Cardíaca Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Circ Heart Fail Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Choque Cardiogénico / Insuficiencia Cardíaca Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Circ Heart Fail Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos