Association between left ventricular ejection fraction, mortality and use of mechanical circulatory support in patients with non-ischaemic cardiogenic shock.

Autor: Sundermeyer J; Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany.; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany., Kellner C; Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany., Beer BN; Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany.; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany., Besch L; Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany.; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany., Dettling A; Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany.; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany., Bertoldi LF; Cardio Center, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy., Blankenberg S; Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany.; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany., Dauw J; Department of Cardiology, AZ Sint-Lucas, Ghent, Belgium., Dindane Z; Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany., Eckner D; Department of Cardiology, Paracelsus Medical University Nürnberg, Nuremberg, Germany., Eitel I; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.; University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany., Graf T; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.; University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany., Horn P; Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany., Jozwiak-Nozdrzykowska J; Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany., Kirchhof P; Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany.; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany., Kluge S; Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Linke A; Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany., Landmesser U; Department of Cardiology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany., Luedike P; Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany., Lüsebrink E; Department of Medicine I, University Hospital, LMU Munich, Munich, Germany., Majunke N; Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany., Mangner N; Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany., Maniuc O; Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany., Winkler SM; Department of Internal Medicine I, University Hospital Jena, Jena, Germany., Nordbeck P; Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany., Orban M; Department of Medicine I, University Hospital, LMU Munich, Munich, Germany., Pappalardo F; Dept Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio E Biagio E Cesare Arrigo, Alessandria, Italy., Pauschinger M; Department of Cardiology, Paracelsus Medical University Nürnberg, Nuremberg, Germany., Pazdernik M; Department of Cardiology, IKEM, Prague, Czech Republic., Proudfoot A; Department of Perioperative Medicine, St. Bartholomew's Hospital, London, UK., Kelham M; Department of Perioperative Medicine, St. Bartholomew's Hospital, London, UK., Rassaf T; Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany., Scherer C; Department of Medicine I, University Hospital, LMU Munich, Munich, Germany., Schulze PC; Department of Internal Medicine I, University Hospital Jena, Jena, Germany., Schwinger RHG; Medizinische Klinik II, Kliniken Nordoberpfalz AG, Weiden, Germany., Skurk C; Department of Cardiology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany., Sramko M; Department of Cardiology, IKEM, Prague, Czech Republic., Tavazzi G; IRCCS S. Maria Nascente-Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy., Thiele H; Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany., Villanova L; Unità Di Cure Intensive Cardiologiche and De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Morici N; IRCCS S. Maria Nascente-Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy., Westenfeld R; Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany., Winzer EB; Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany., Westermann D; Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany., Schrage B; Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany. b.schrage@uke.de.; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany. b.schrage@uke.de.
Jazyk: angličtina
Zdroj: Clinical research in cardiology : official journal of the German Cardiac Society [Clin Res Cardiol] 2024 Apr; Vol. 113 (4), pp. 570-580. Date of Electronic Publication: 2023 Nov 20.
DOI: 10.1007/s00392-023-02332-y
Abstrakt: Background: Currently, use of mechanical circulatory support (MCS) in non-ischaemic cardiogenic shock (CS) is predominantly guided by shock-specific markers, and not by markers of cardiac function. We hypothesise that left ventricular ejection fraction (LVEF) can identify patients with a higher likelihood to benefit from MCS and thus help to optimise their expected benefit.
Methods: Patients with non-ischaemic CS and available data on LVEF from 16 tertiary-care centres in five countries were analysed. Cox regression models were fitted to evaluate the association between LVEF and mortality, as well as the interaction between LVEF, MCS use and mortality.
Results: N = 807 patients were analysed: mean age 63 [interquartile range (IQR) 51.5-72.0] years, 601 (74.5%) male, lactate 4.9 (IQR 2.6-8.5) mmol/l, LVEF 20 (IQR 15-30) %. Lower LVEF was more frequent amongst patients with more severe CS, and MCS was more likely used in patients with lower LVEF. There was no association between LVEF and 30-day mortality risk in the overall study cohort. However, there was a significant interaction between MCS use and LVEF, indicating a lower 30-day mortality risk with MCS use in patients with LVEF ≤ 20% (hazard ratio 0.72, 95% confidence interval 0.51-1.02 for LVEF ≤ 20% vs. hazard ratio 1.31, 95% confidence interval 0.85-2.01 for LVEF > 20%, interaction-p = 0.017).
Conclusion: This retrospective study may indicate a lower mortality risk with MCS use only in patients with severely reduced LVEF. This may propose the inclusion of LVEF as an adjunctive parameter for MCS decision-making in non-ischaemic CS, aiming to optimise the benefit-risk ratio.
(© 2023. The Author(s).)
Databáze: MEDLINE
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