Afterload-related cardiac performance is a powerful hemodynamic predictor of mortality in patients with chronic heart failure

Wu, Yicheng; Tian, Pengchao; Liang, Lin; Chen, Yu-Yi; Feng, Jiayu; Huang, Boping; Huang, Liyan; Zhao, Xuemei; Wang, Jing; Guan, Jingyuan; Li, Xinqing; Zhang, Yuhui; Zhang, Jian

doi:10.1177/20406223231171554

Cited by 3 publications

(1 citation statement)

References 25 publications

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“…It has been demonstrated that parameters, such as Cardiac Power Index, Cardiac Output, Cardiac Index and Stroke Volume, could potentially hold prognostic relevance in the context of cardiogenic shock [39]. Likewise, evaluating the prediction of afterload-related cardiac performance would be of interest [40]. However, these parameters are not adequately represented in this registry and should be the focus of future research endeavours dedicated to LVEF in non-ischaemic cardiogenic shock.…”

Section: Limitationsmentioning

confidence: 99%

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

Sundermeyer,

Kellner,

Beer

et al. 2023

Clin Res Cardiol

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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. Graphical abstract Impact of left ventricular ejection fraction on mortality and use of mechanical circulatory support in non-ischaemic cardiogenic shock. Hazard ratio for 30-day mortality across the LVEF continuum, adjusted for age, sex, SCAI shock stage, worst value of lactate and pH within 6 h, prior resuscitation and mechanical ventilation during the index shock event. LVEF: Left ventricular ejection fraction; MCS: Mechanical circulatory support; HR: Hazard ratio; CI: Confidence interval.

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Section: Limitationsmentioning

confidence: 99%

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

Sundermeyer,

Kellner,

Beer

et al. 2023

Clin Res Cardiol

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Septic cardiomyopathy—diagnosis and estimation of disease severity

Müller-Werdan,

Vogt,

Werdan

2024

Med Klin Intensivmed Notfmed

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Zusammenfassung Hintergrund Die septische Kardiomyopathie (sKM) wird in ihrer Relevanz häufig unterschätzt. Die Unterschätzung basiert auf der komplexen Schädigung des Herzens und der Schwierigkeit, den Schweregrad der Funktionseinschränkung zu quantifizieren. Ziel der Arbeit Darstellung der methodischen Möglichkeiten zur Diagnosestellung und Schweregradquantifizierung der sKM. Methodik Literatursichtung und Analyse der wesentlichen Ergebnisse. Ergebnisse Die sKM ist charakterisiert sowohl durch eine systolische als auch diastolische Funktionsstörung nicht nur des linken, sondern auch des rechten Ventrikels sowie durch eine Sinustachykardiomyopathie (≥ 90–95 Schläge/min) variablen Ausmaßes. „Sepsis-related organ failure assessment“ (SOFA)Score, linksventrikuläre Auswurffraktion (LVEF), EKG und kardiale Biomarker sind zur Schweregradquantifizierung nicht hilfreich. Erforderlich dazu ist entweder eine „komplexe“ Echokardiographiediagnostik oder die Bestimmung globaler Herzfunktionsparameter, die die Nachlastabhängigkeit des Herzzeitvolumens (HZV) bei der ausgeprägten Vasodilatation in der Sepsis und im septischen Schock berücksichtigen. Ein entsprechender, mittels HZV-Messung zu ermittelnder Parameter ist „afterload-related cardiac performance“ (ACP), der den Prozentsatz des HZV des Sepsispatienten bei dem jeweiligen Gefäßwiderstand in Relation zum HZV eines gesunden Herzens angibt. Die ACP-Bestimmung zeigt, dass mindestens jeder zweite Sepsispatient eine Herzfunktionseinschränkung aufweist und dass diese mit zunehmendem Schweregrad die Sterblichkeit erhöht. Diskussion Einfache Parameter wie die LVEF sind zur Diagnostik und Schweregradklassifizierung der sKM nicht hilfreich. Dazu sind entweder „komplexe“ Echokardiographiemessungen oder – am besten validiert – die ACP-Bestimmung geeignet.

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Association between afterload-related cardiac performance and acute kidney injury in patients with sepsis: a retrospective cohort study

Zheng,

Guo,

et al. 2024

Preprint

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BackgroundIt is believed that there is a complex bidirectional causal and pathophysiological relationship between heart and kidney in sepsis. Afterload-related cardiac performance (ACP) has been found to have a close association with cardiac function and prognosis in sepsis. The aim of this study was to explore its correlation with sepsis-associated acute kidney injury (SA-AKI).Methods150 patients with sepsis who underwent PiCCO were included. Restricted cubic spline (RCS) and Cox proportional hazards regression were used to describe the relationship between ACP and SA-AKI. The receiver operating characteristic curve (AUROC) analysis was used to evaluate the predictive value of ACP for SA-AKI. A prediction model of SA-AKI occurrence probability within 7 days was presented by nomogram.Results67.3% patients developed SA-AKI within 7 days. The RCS model demonstrated that the risk of SA-AKI increased with the decrease of ACP. Cox regression analyses also found an independent inverse association between them (HR 0.974, 95%CI 0.963 - 0.985, p < 0.001). ACP showed significantly greater discrimination for SA-AKI than CI (p= 0.004). Independent risk factors for SA-AKI within 7 days were history of hypertension, type of pathogens, SOFA score, serum potassium and ACP. The AUROC of the nomogram established by age and the above factors was 0.865 (95%CI 0.808 – 0.923,p< 0.001) and the C-index was 0.800 (95%CI 0.753 - 0.847).ConclusionsLow ACP was associated with an increased risk of SA-AKI within 7 days. ACP, which might be superior to CI, had the potential for early prediction of SA-AKI.

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Afterload-related cardiac performance is a powerful hemodynamic predictor of mortality in patients with chronic heart failure

Cited by 3 publications

References 25 publications

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

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

Septic cardiomyopathy—diagnosis and estimation of disease severity

Association between afterload-related cardiac performance and acute kidney injury in patients with sepsis: a retrospective cohort study

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