scholarly journals AMI causing cardiogenic shock in patients with severely depressed left ventricular function

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
R Caldeira Da Rocha ◽  
B Picarra ◽  
F Claudio ◽  
M Carrigton ◽  
J Pais ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Left Main ◽  
Severe Left Ventricular Dysfunction ◽  
Group 1

Abstract Introduction Left ventricular function is assumed to be the main predictor of cardiogenic shock (CS), however trials and registries show that in average left ventricular function is only moderately depressed in CS after acute myocardial infarction. Purpose Characterize population of patients (Pts) with CS after acute myocardial infarction (AMI) and with severe left ventricular dysfunction (defined as ejection fraction (EF) <30%). Methods From a national multicenter registry, we evaluated 729ptswith CS after AMI.We considered 2 groups: Group 1 – pts with CS and EF <30% and Group 2 – pts with CS and EF >30%. We registered age, gender, cardiovascular and non-cardiovascular comorbidities, electrocardiographic presentation, vital signs at admission, reperfusion strategy and coronary anatomy. We also evaluated in-hospital complications, such as re-infarction, mechanical complications, high-grade atrial ventricular block, sustained ventricular tachycardia (VT), atrial fibrillation (AF) and stroke. We compared in-hospital mortality and multivariate analysis was performed to assess the impact of EF in in-hospital mortality and to identify predictors of severe left ventricular function. Results Severe dysfunction in Cardiogenic shock due to AMI was present in 28.9% (n=211) of pts (68% male, mean age of 72±12 years old). Group 1 had higher incidence of previous heart disease, such as AMI, previous PCI and congestive heart failure (27% vs 14%, p<0.001; 17.7% vs 9.6% p=0.002 and 16% vs 10%, p=0.022, respectively). STEMI pts were 71% (n=149), and timing from symptoms until first contact was longer (185 min (90; 437) vs 123 (60; 300), p<0.001). Undetermined location AMI was more often in group 1 (8% vs 2%, p<0.001), particularly due to left or right bundle brunch block (13% vs 4.7%, p<0.001, and 15% vs 10%, p=0.041 respectively). Anterior STEMI was also more prevalent in this groups (81% vs 46%, p<0.001). No differences were observed on coronariography rate, rate or type of reperfusion nor multivessel disease. Group 1 pts presented more with left main (LM) (25% vs 12%, p<0.001) and anterior descending (AD) (9.4% vs 2.4%, p<0.001) arteries lesions (88% vs 72.4%, p<0.001) or occlusion (65.5% vs 33.7%, p<0.001). Group 1 presented more with in-hospital VT (16% vs 10.8%, p=0.048). In-hospital mortality was also higher (56.5% vs 29.5%, p<0.001). After multivariate analysis we found that severe left ventricular dysfunction was a mortality predictor (OR 3.37; 95% CI 2.05–5.54, p<0.001). LM (OR 3.41; 95% CI 1.86–6.26, p<0.001) and AD (OR 2.74; 95% CI 1.51–4.96, p=0.001) arteries disease and previous AMI (OR 2.36; 95% CI 1.28–4.37, p=0.006) were predictors of severe LV dysfunction. Conclusions Severely depressed EF is a predictor of in-hospital mortality. Left main and anterior descending artery disease and previous AMI were identified as predictors of an EF <30%. FUNDunding Acknowledgement Type of funding sources: None.

P2265Cardiogenic shock without severe left ventricular dysfunction after ST-elevation acute myocardial infarction: population characterization and impact in prognosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
B Picarra ◽  
J A Pais ◽  
A R Santos ◽  
M Carrington ◽  
D Bras ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Severe Left Ventricular Dysfunction ◽  
St Elevation ◽  
Group 1

Abstract Background The presence of cardiogenic shock (CS) after ST-elevation acute myocardial infarction (STEMI) is associated with a high mortality. Traditionally, severe left ventricular dysfunction is assumed to be the main predictor of CS, however trials and registries show that in average left ventricular function is only moderately depressed in CS after acute myocardial infarction. Purpose To characterize the population of patients (Pts) with CS after STEMI but without severe left ventricular dysfunction and assess their impact in mortality. Methods From a national multicenter registry, we evaluated 7181 Pts with STEMI and ejection fraction (EF) >30%, and excluded all pts with STEMI and an EF<30%. We considered 2 groups: Group 1 – Pts who developed CS and Group 2 - Pts who didn't developed CS. We registered age, gender, cardiovascular and non-cardiovascular co-morbidities, electrocardiographic presentation, vital signs at admission, reperfusion strategies, reperfusion times and coronary anatomy. We evaluated the following in-hospital complications: Re-Infarction, mechanical complications, high-grade atrial ventricular block, sustained ventricular tachycardia (VT) atrial fibrillation (AF) and stroke. We compared the in-hospital mortality. Results The presence of CS without severe left ventricular dysfunction was observed in 5,2% pts (n=376), being CS present at admission in 51,2% of these pts. The mean EF was lower in group 1 pts (44% ± 11 vs 51±11%, p<0,001). Patients in group 1 were older (70±14 vs 63±13 years, p<0,001), more females (39,4% vs 23,3%, p<0,001), had a higher prevalence of previous valvular heart disease (2,7% vs 1,0%, p=0,005), heart failure (4,8% vs 1,4%, p<0,001, peripheral artery disease (5,5% vs 2,9%, p=0,004), chronic kidney disease (6,4% vs 2,7%, p<0,001) and chronic pulmonary obstructive disease (8,2% vs 3,1%, p<0,001). At admission, Group 1 pts had more atrial fibrillation (10,4% vs 4,4%, p<0,001) and received less reperfusion (77,7% vs 83,0%, p=0,008), without differences in the type of reperfusion or times to reperfusion. The presence of multivessel disease (60,0% vs 45,7%, p<0,001) and left main disease (6,6% vs 2,4%, p<0,001) were more prevalent in Group 1 pts. Group 1 pts had more in-hospital complications: Re-Infarction (3,5% vs 0,7%, p<0,001), AF (22,1% vs 5,0%, p<0,001), mechanical complications (9,6% vs 0,5%, p<0,001), high atrial ventricular block (26,7% vs 3,7%, p<0,001), VT (10,6% vs 1,9%, p<0,001), stroke (1,9% vs 0,6%, p=0,01) and major bleeding (10,4% vs 1,5%, p<0,001). In-hospital mortality was much higher in Group 1 pts (26,6% vs 1,4%, p<0,001). Conclusions Cardiogenic shock is present in 5,2% of STEMI pts without severe ventricular dysfunction. These pts were older, more frequent female, had higher morbidities and in-hospital complications. Even without severe ventricular dysfunction, cardiogenic shock in these patients was associated with much higher in-hospital mortality.

Cardiogenic shock without severe left ventricular dysfunction after acute myocardial infarction: population characterization and impact in prognosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B.C Picarra ◽  
A.R Santos ◽  
J.A Pais ◽  
M Carrington ◽  
D Bras ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Ejection Fraction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Severe Left Ventricular Dysfunction ◽  
Group 1

Abstract Introduction Traditionally, severe left ventricular dysfunction is assumed to be the main predictor of CS afte acute myocardial infarction (AMI), however trials and registries show that in average left ventricular function is only moderately depressed in CS after acute myocardial infarction. Purpose To characterize the population of patients (Pts) with CS after AMI but without severe left ventricular dysfunction (defined as ejection fraction &gt;30%) and assess their impact in mortality. Methods From a national multicenter registry, we evaluated 16332 Pts with AMI and ejection fraction (EF) &gt;30%. We considered 2 groups: Group 1 – Pts who developed CS and Group 2 – Pts who didn't developed CS. We registered age, gender, cardiovascular and non-cardiovascular co-morbidities, electrocardiographic presentation and coronary anatomy. We also evaluated the following in-hospital complications: Re-Infarction, mechanical complications, high-grade atrial ventricular block, sustained ventricular tachycardia (VT) atrial fibrillation (AF) and stroke. We compared the in-hospital mortality. Results The presence of CS without severe left ventricular dysfunction was observed in 3,2% pts (n=518) with AMI, being CS present at admission in 46,8% of these pts. The mean EF was lower in group 1 pts (44% ± 11 vs 53±11%, p&lt;0,001). Patients in group 1 were older (71±13 vs 65±13 years, p&lt;0,001), more females (38,8% vs 26,6%, p&lt;0,001), had a higher prevalence of previous valvular heart disease (6,1% vs 3,0%, p&lt;0,001), heart failure (10,1% vs 4,8%, p&lt;0,001, peripheral artery disease (7,5% vs 5,3%, p=0,03), chronic kidney disease (9,8% vs 5,4%, p&lt;0,001), chronic pulmonary obstructive disease (9,1% vs 4,9%, p&lt;0,001) and previous stroke (11,0% vs 7,2%, p&lt;0,001). At admission, Group 1 pts had more ST-elevation AMI (72,6% vs 43,0%, p&lt;0,001), more AF (11,4% vs 6,6%, p&lt;0,001) and more right bundle block (9,9%% vs 5,8%, p&lt;0,001). Group 1 patients received less coronary angiography (80,9% vs 88,2%, p&lt;0,00. The presence of multivessel disease (64,3% vs 51,4%, p&lt;0,001), left main disease (12,2% vs 7,2%, p&lt;0,001), left anterior descending disease (72,4% vs 64,3%, p&lt;0,001) and right coronary disease (64,8% vs 55,5%, p&lt;0,001) were more prevalent in Group 1 pts. Group 1 pts had more in-hospital complications: Re-Infarction (4,4% vs 0,9%, p&lt;0,001), AF (23,0% vs 4,3%, p&lt;0,001), mechanical complications (8,9% vs 0,3%, p&lt;0,001), high atrial ventricular block (21,9% vs 2,3%, p&lt;0,001), VT (10,8% vs 1,2%, p&lt;0,001) and major bleeding (8,9% vs 1,3%, p&lt;0,001). In-hospital mortality was also much higher in Group 1 pts (29,5% vs 1,2%, p&lt;0,001). Conclusions Cardiogenic shock is present in 3,2% of AMI pts without severe ventricular dysfunction. These pts were older, more frequent female, had higher morbidities and in-hospital complications. Even without severe ventricular dysfunction, cardiogenic shock in these patients was associated with a much higher in-hospital mortality. Funding Acknowledgement Type of funding source: None

Right Ventricular Function is Important for Pulmonary Artery Banding in Left Ventricular Dysfunction

2017 ◽  
Vol 11 (4) ◽  
pp. NP103-NP106 ◽  
Author(s):  
Lloyd M. Felmly ◽  
Andrew J. Savage ◽  
Minoo N. Kavarana
Keyword(s):  
Pulmonary Artery ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Left Ventricular Dysfunction ◽  
Poor Prognosis ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Pulmonary Artery Banding ◽  
Mechanical Support ◽  
Severe Left Ventricular Dysfunction

Small infants with severe left ventricular dysfunction (LVD) carry a poor prognosis with limited therapeutic options. Although mechanical support and heart transplantation are definitive therapies, improvement of left ventricular function with reversible pulmonary artery banding (rPAB) has been described. We report two cases of LVD treated with rPAB. One was successfully temporized, and one progressed to requiring transplantation, indicating that appropriate patient selection is critical to this technique's success.

Sign in / Sign up

Export Citation Format

Share Document