Hemodynamic Profiles of Shock in Patients with COVID-19
| Autor: | Steven M. Hollenberg, Noha Gayed, Matthew Fata, Ronaldo C. Go, Zoltan G. Turi, Jana Tancredi, Lucy Safi, Brent Klinkhammer, Roshan Shah, David Landers, Elli Gourna-Paleoudis, Taya V. Glotzer, Sameer Jamal, Neel Shah, Joseph E. Parrillo |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Cardiac index Hemodynamics Comorbidity shock hemodynamics Article Internal medicine medicine Humans echocardiography Prospective Studies Prospective cohort study Pandemics Aged Ejection fraction business.industry SARS-CoV-2 Incidence COVID-19 Stroke volume Middle Aged United States Blood pressure Shock (circulatory) Cohort Cardiology Female medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | The American Journal of Cardiology |
| ISSN: | 1879-1913 0002-9149 |
| Popis: | Patients with serious COVID infections develop shock frequently. To characterize the hemodynamic profile of this cohort, 156 patients with COVID pneumonia and shock requiring vasopressors had interpretable echocardiography with measurement of ejection fraction (EF) by Simpson's rule and stroke volume (SV) by Doppler. RV systolic pressure (RVSP) was estimated from the tricuspid regurgitation peak velocity. Patients were divided into groups with low or preserved EF (EFL or EFP, cutoff ≤45%), and low or normal cardiac index (CIL or CIN, cutoff ≤2.2 L/min/m2). Mean age was 67 ± 12.0, EF 59.5 ± 12.9, and CI 2.40 ± 0.86. A minority of patients had depressed EF (EFLCIL, n = 15, EFLCIN, n = 8); of those with preserved EF, less than half had low CI (EFPCIL, n = 55, EFPCIN, n = 73). Overall hospital mortality was 73%. Mortality was highest in the EFLCIL group (87%), but the difference between groups was not significant (p = 0.68 by ANOVA). High PEEP correlated with low CI in the EFPCIL group (r = 0.44, p = 0.04). In conclusion, this study reports the prevalence of shock characterized by EF and CI in patients with COVID-19. COVID-induced shock had a cardiogenic profile (EFLCIL) in 9.6% of patients, reflecting the impact of COVID-19 on myocardial function. Low CI despite preservation of EF and the correlation with PEEP suggests underfilling of the LV in this subset; these patients might benefit from additional volume. Hemodynamic assessment of COVID patients with shock with definition of subgroups may allow therapy to be tailored to the underlying causes of the hemodynamic abnormalities. |
| Databáze: | OpenAIRE |
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