Doppler-derived haemodynamics performed during admission echocardiography predict in-hospital mortality in cardiac intensive care unit patients.

Autor:	Jentzer JC; Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905, USA.; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905, USA.; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA., Tabi M; Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905, USA.; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905, USA., Wiley BM; Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905, USA.; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905, USA., Lanspa MJ; Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, University of Utah, Murray, UT 84132, USA., Anavekar NS; Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905, USA.; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905, USA., Oh JK; Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905, USA.; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905, USA.
Jazyk:	angličtina
Zdroj:	European heart journal. Acute cardiovascular care [Eur Heart J Acute Cardiovasc Care] 2022 Aug 09; Vol. 11 (8), pp. 640-650.
DOI:	10.1093/ehjacc/zuac084
Abstrakt:	Aims: Cardiac point-of-care ultrasound (CV-POCUS) has become a fundamental part for the assessment of patients admitted to cardiac intensive care units (CICU). We sought to refine the practice of CV-POCUS by identifying 2D and Doppler-derived measurements from bedside transthoracic echocardiograms (TTEs) performed in the CICU that are associated with mortality. Methods and Results: We retrospectively included Mayo Clinic CICU patients admitted from 2007 to 2018 and assessed the TTEs performed within 1 day of CICU admission, including Doppler and 2D measurements of left and right ventricular function. Logistic regression and classification and regression tree (CART) analysis were used to determine the association between TTE variables with in-hospital mortality. A total of 6957 patients were included with a mean age of 68.0 ± 14.9 years (37.0% females). A total of 609 (8.8%) patients died in the hospital. Inpatient deaths group had worse biventricular systolic function [left ventricular ejection fraction (LVEF) 48.2 ± 16.0% vs. 38.7 ± 18.2%, P < 0.0001], higher filling pressures, and lower forward flow. The strongest TTE predictors of hospital mortality were left ventricular outflow tract velocity-time integral [LVOT VTI, adjusted OR 0.912 per 1 cm higher, 95% confidence interval (CI) 0.883-0.942, P < 0.0001] followed by medial mitral E/e' ratio (adjusted OR 1.024 per 1 unit higher, 95% CI 1.010-1.039, P = 0.0011). Classification and regression tree analysis identified LVOT VTI <16 cm as the most important TTE predictor of mortality. Conclusions: Doppler-derived haemodynamic TTE parameters have a strong association with mortality in the CICU, particularly LVOT VTI <16 cm or mitral E/e' ratio >15. The incorporation of these simplified Doppler-derived haemodynamics into admission CV-POCUS facilitates early risk stratification and strengthens the clinical yield of the ultrasound exam. Competing Interests: Conflict of interest: None of the authors has a significant conflict of interest related to this research. (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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