Invasive Phenoprofiling of Acute-Myocardial-Infarction-Related Cardiogenic Shock.

Autor: Ortega-Hernández JA; Instituto Nacional de Cardiología Ignacio Chávez, Coronary Care Unit, Juan Badiano 1, Sección XVI, Tlalpan, Ciudad De Mexico 14080, Mexico., González-Pacheco H; Instituto Nacional de Cardiología Ignacio Chávez, Coronary Care Unit, Juan Badiano 1, Sección XVI, Tlalpan, Ciudad De Mexico 14080, Mexico., Argüello-Bolaños J; Instituto Nacional de Cardiología Ignacio Chávez, Coronary Care Unit, Juan Badiano 1, Sección XVI, Tlalpan, Ciudad De Mexico 14080, Mexico., Arenas-Díaz JO; Instituto Nacional de Cardiología Ignacio Chávez, Coronary Care Unit, Juan Badiano 1, Sección XVI, Tlalpan, Ciudad De Mexico 14080, Mexico., Pérez-López R; Instituto Nacional de Cardiología Ignacio Chávez, Coronary Care Unit, Juan Badiano 1, Sección XVI, Tlalpan, Ciudad De Mexico 14080, Mexico., García-Arias MR; Instituto Nacional de Cardiología Ignacio Chávez, Coronary Care Unit, Juan Badiano 1, Sección XVI, Tlalpan, Ciudad De Mexico 14080, Mexico., Gopar-Nieto R; Instituto Nacional de Cardiología Ignacio Chávez, Coronary Care Unit, Juan Badiano 1, Sección XVI, Tlalpan, Ciudad De Mexico 14080, Mexico., Sierra-Lara-Martínez D; Instituto Nacional de Cardiología Ignacio Chávez, Coronary Care Unit, Juan Badiano 1, Sección XVI, Tlalpan, Ciudad De Mexico 14080, Mexico., Araiza-Garaygordobil D; Instituto Nacional de Cardiología Ignacio Chávez, Coronary Care Unit, Juan Badiano 1, Sección XVI, Tlalpan, Ciudad De Mexico 14080, Mexico., Manzur-Sandoval D; Instituto Nacional de Cardiología Ignacio Chávez, Coronary Care Unit, Juan Badiano 1, Sección XVI, Tlalpan, Ciudad De Mexico 14080, Mexico., Soliz-Uriona LA; Instituto Nacional de Cardiología Ignacio Chávez, Coronary Care Unit, Juan Badiano 1, Sección XVI, Tlalpan, Ciudad De Mexico 14080, Mexico., Astudillo-Alvarez GM; Instituto Nacional de Cardiología Ignacio Chávez, Coronary Care Unit, Juan Badiano 1, Sección XVI, Tlalpan, Ciudad De Mexico 14080, Mexico., Hernández-Montfort J; Advanced Heart Failure and Recovery Program for Central Texas Baylor Scott & White Health, 302 University Blvd, Round Rock, TX 78665, USA., Arias-Mendoza A; Instituto Nacional de Cardiología Ignacio Chávez, Coronary Care Unit, Juan Badiano 1, Sección XVI, Tlalpan, Ciudad De Mexico 14080, Mexico.
Jazyk: angličtina
Zdroj: Journal of clinical medicine [J Clin Med] 2023 Sep 07; Vol. 12 (18). Date of Electronic Publication: 2023 Sep 07.
DOI: 10.3390/jcm12185818
Abstrakt: Background: Studies had previously identified three cardiogenic shock (CS) phenotypes (cardiac-only, cardiorenal, and cardiometabolic). Therefore, we aimed to understand better the hemodynamic profiles of these phenotypes in acute myocardial infarction-CS (AMI-CS) using pulmonary artery catheter (PAC) data to better understand the AMI-CS heterogeneity.
Methods: We analyzed the PAC data of 309 patients with AMI-CS. The patients were classified by SCAI shock stage, congestion profile, and phenotype. In addition, 24 h hemodynamic PAC data were obtained.
Results: We identified three AMI-CS phenotypes: cardiac-only (43.7%), cardiorenal (32.0%), and cardiometabolic (24.3%). The cardiometabolic phenotype had the highest mortality rate (70.7%), followed by the cardiorenal (52.5%) and cardiac-only (33.3%) phenotypes, with significant differences ( p < 0.001). Right atrial pressure ( p = 0.001) and pulmonary capillary wedge pressure ( p = 0.01) were higher in the cardiometabolic and cardiorenal phenotypes. Cardiac output, index, power, power index, and cardiac power index normalized by right atrial pressure and left-ventricular stroke work index were lower in the cardiorenal and cardiometabolic than in the cardiac-only phenotypes. We found a hazard ratio (HR) of 2.1 for the cardiorenal and 3.3 for cardiometabolic versus the cardiac-only phenotypes ( p < 0.001). Also, multi-organ failure, acute kidney injury, and ventricular tachycardia/fibrillation had a significant HR. Multivariate analysis revealed that CS phenotypes retained significance ( p < 0.001) when adjusted for the Society for Cardiovascular Angiography & Interventions score ( p = 0.011) and ∆congestion ( p = 0.028). These scores independently predicted mortality.
Conclusions: Accurate patient prognosis and treatment strategies are crucial, and phenotyping in AMI-CS can aid in this effort. PAC profiling can provide valuable prognostic information and help design new trials involving AMI-CS.
Databáze: MEDLINE
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