Sustained ventricular tachycardia in cardiogenic shock

Abstract

Funding Acknowledgements Type of funding sources: None. Introduction Cardiogenic shock (CS) and the presence of sustained ventricular tachycardia (VT) are indicators of worse prognosis in hospitalized patients. In patients severely ill, like patients with CS, the registration of VT can be a stressful situation as well a life threatening condition. Purpose Evaluate the impact of cardiovascular previous history, clinical signs and diagnosis procedures at admission as predictors of VT in CS patients. Methods Single-centre retrospective study, engaging patients hospitalized for CS between 1/01/2014-30/10/2018. 222 patients with CS are included, 19 of them presented VT. Chi-square test, T-student test and Mann-Whitney U test were used to compare categorical and continuous variables. Multiple linear regression analysis was performed to evaluate predictors of new-onset AF in CS patients. Results CS patients without VT and with VT presented similar age, sex, cardiovascular history (namely arterial hypertension, diabetes, dyslipidemia, obesity, smoker status, alcohol intake, previous acute coronary syndrome, history of angina, previous cardiomyopathy), neoplasia history, cardiac arrest during the CS, clinical signs at admission (like heart rate, blood pressure, respiratory rate), blood results (hemoglobin, leucocytes, troponin, creatinine, C-Reactive protein), left ventricular ejection fraction and the culprit lesion. Curiously, history of previous stroke was higher in the group of VT in CS patients with a 6.9% (p = 0.021). Curiously, VT in CS patient had not impact in mortality rates. Multiple logistic regression reveals that previous stroke was a predictor of VT in CS patients (odds ratio 4.337, confident interval 1.363-13.799, p = 0.013). Conclusions History of previous stroke was a predictor of sustained VT in CS patients. The presence of this ventricular arrhythmia can have a hemodynamic impact, however, seems not influenced mortality rates.

One-year outcomes in cardiogenic shock triggered by ventricular arrhythmia: An analysis of the FRENSHOCK multicenter prospective registry

“…Hence, the more frequent need for heart transplantation or VAD in the VA group without mortality difference suggest considering the occurrence of life-threatening VA as a pejorative turning point in heart failure, indicating a progression through the stages of disease severity. A retrospective monocentric study ( 14 ) directed on 222 patients (with 14 VT triggered CS) found similar results, emphasizing that even if VA can have a hemodynamic impact, it does not seem to increase early mortality. However, others reported that end-stage heart failure was the main cause of death after an electrical storm ( 20 ) which is consistent with our results considering all types of ventricular arrhythmia.…”

“…Furthermore, the relationship between VA and heart failure is still under debate ( 10 ). Even if mounting evidence indicates that high VA burden seems closely linked to mortality and outcomes in many settings of chronic heart failure ( 11 – 13 ), their significance in the context of CS remains unclear: whether the VA-triggered CS results in worse long-term outcomes than the non-VA-triggered one is not established ( 14 ).…”