scholarly journals Patient Characteristics, Treatment and Outcome in Non-Ischemic vs. Ischemic Cardiogenic Shock

2020 ◽  
Vol 9 (4) ◽  
pp. 931 ◽  
Author(s):  
Benedikt Schrage ◽  
Jessica Weimann ◽  
Salim Dabboura ◽  
Isabell Yan ◽  
Rafel Hilal ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Cox Regression ◽  
Treatment Strategies ◽  
Patient Characteristics ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist

Aim: Evidence on non-ischemic cardiogenic shock (CS) is scarce. The aim of this study was to investigate differences in patient characteristics, use of treatments and outcomes in patients with non-ischemic vs. ischemic CS. Methods: Patients with CS admitted between October 2009 and October 2017 were identified and stratified as non-ischemic/ischemic CS based on the absence/presence of acute myocardial infarction. Logistic/Cox regression models were fitted to investigate the association between non-ischemic CS and patient characteristics, use of treatments and 30-day in-hospital mortality. Results: A total of 978 patients were enrolled in this study; median age was 70 (interquartile range 58, 79) years and 70% were male. Of these, 505 patients (52%) had non-ischemic CS. Patients with non-ischemic CS were more likely to be younger and female; were less likely to be active smokers, to have diabetes or decreased renal function, but more likely to have a history of myocardial infarction; and they were more likely to present with unfavorable hemodynamics and with mechanical ventilation. Regarding treatments, patients with non-ischemic CS were more likely to be treated with catecholamines, but less likely to be treated with extracorporeal membrane oxygenation or percutaneous left-ventricular assist devices. After adjustment for multiple relevant confounders, non-ischemic CS was associated with a significant increase in the risk of 30-day in-hospital mortality (hazard ratio 1.14, 95% confidence interval 1.04–1.24, p < 0.01). Conclusion: In this large study, non-ischemic CS accounted for more than 50% of all CS cases. Non-ischemic CS was not only associated with relevant differences in patient characteristics and use of treatments, but also with a worse prognosis. These findings highlight the need for effective treatment strategies for patients with non-ischemic CS.

Presentation characteristics, use of treatments and outcomes in patients with ischaemic vs. non-ischaemic cardiogenic shock

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Schrage ◽  
S Dabboura ◽  
I Yan ◽  
R Hilal ◽  
J Weimann ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Cox Regression ◽  
Chronic Renal Disease ◽  
Tertiary Care ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Care Hospital ◽  
Left Ventricular Assist Devices

Abstract Aim Evidence on non-ischaemic cardiogenic shock (CS) is scarce. The aim of this study was to investigate differences in presentation characteristics, use of treatments and outcomes in patients with ischaemic vs. non-ischaemic CS. Methods Patients with CS admitted to a tertiary care hospital between October 2009 and October 2017 were identified and stratified as ischaemic CS/non-ischaemic CS based on the presence/absence of acute myocardial infarction. Missing data was handled by chained equation multiple imputation. Logistic and Cox regression models were fitted to investigate the association of non-ischaemic CS with presentation characteristics (adjusted for all baseline variables), and use of treatments as well as30-day in-hospital mortality (adjusted for relevant confounders including age, sex, prior cardiac arrest, haemodynamics, pH and lactate). Results A total of 978 patients were enrolled in this study; median age was 70 (interquartile range 58, 79) years and 70% were male. 505 patients (43%) had non-ischaemic CS. Patients with non-ischaemic CS were more likely younger and female; were less likely to be active smokers or to have diabetes, but more likely to have chronic renal disease and history of myocardial infarction; and were more likely to present with unfavourable haemodynamics and with mechanical ventilation. Regarding use of treatments, patients with non-ischaemic CS were more likely to be treated with catecholamines [odds ratio (OR) 1.58, 95% confidence interval (CI) 1.11–2.27, p0.01], but less likely to be treated with extracorporeal membrane oxygenation (OR 0.66, 95% CI 0.48–0.92, p=0.02) or percutaneous left ventricular assist devices (OR 0.51, 0.35–0.74, p&lt;0.01). Unadjusted survival probabilities in patients with non-ischaemic vs. ischaemic CS were 36% (95% CI 32–42%) vs. 39% (95% CI 35–45%). After adjustment for multiple relevant confounders, non-ischaemic CS was associated with a significant increase in the risk of 30-day in-hospital mortality (hazard ratio 1.30, 95% CI 1.09–1.55, p&lt;0.01, Figure 1). Conclusion In this large study, non-ischaemic CS accounted for almost 50% of all CS cases. Non-ischaemic CS was not only associated with relevant differences in presentation characteristics and use of treatments, but also with a worse prognosis. These findings highlight the need for effective treatment strategies for patients with non-ischaemic CS. Figure 1 Funding Acknowledgement Type of funding source: None

Cardiogenic Shock – Developments and Treatment Strategies

2009 ◽  
Vol 5 (2) ◽  
pp. 48 ◽  
Author(s):  
Ricardo Seabra-Gomes ◽  
Jorge Ferreira ◽  
◽  
Keyword(s):  
Cardiogenic Shock ◽  
Early Recognition ◽  
Treatment Strategies ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Significant Treatment ◽  
Ventricular Assist ◽  
Hard Data ◽  
Oxide Synthase

Cardiogenic shock remains one of the most serious and challenging conditions in cardiology and is responsible for the highest in-hospital mortality associated with ST-elevation myocardial infarction. The only significant treatment strategy that has been shown to reduce its incidence and inherent mortality is emergent coronary revascularisation. Prevention should aim at early recognition of symptoms, appropriate pre-hospital emergency medical care and prompt primary revascularisation. Once established, cardiogenic shock still has an unacceptably high mortality rate. Approaches that include new pharmacological therapies and other forms of mechanical haemodynamic support are under investigation. The possible role of systemic inflammatory response has led to the investigation of nitric oxide synthase inhibition, although initial results with tilarginine were disappointing. The use of percutaneous left ventricular assist devices looks promising, but hard data regarding mortality benefit are still missing. Cardiogenic shock remains a perplexing and often fatal condition. The future may require more basic, translational and clinical research.

scholarly journals Intra‐Aortic Balloon Pump as a Bridge to Durable Left Ventricular Assist Device

2021 ◽  
Author(s):  
Matthew A. Brown ◽  
Farooq H. Sheikh ◽  
Sara Ahmed ◽  
Samer S. Najjar ◽  
Ezequiel J. Molina
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Left Ventricular Assist

Abstract Left ventricular assist devices (LVAD) are increasingly being used as destination therapy in patients with Stage D heart failure. It has been reported that a majority of patients who receive a durable LVAD (dLVAD) present in cardiogenic shock due to decompensated heart failure (ADHF‐CS). As it stands, there is no consensus on the optimal management strategy for patients presenting with ADHF. Bridging with intra‐aortic balloon pumps (IABPs) continues to be a therapeutic option in patients with hemodynamic instability due to cardiogenic shock. The majority of data regarding the use of IABP in cardiogenic shock come from studies in patients presenting with acute myocardial infarction with cardiogenic shock and demonstrates that there is no benefit of routine IABP use in this patient population. However, the role of IABPs as a bridge to dLVAD in ADHF‐CS has yet to be determined. The hemodynamic changes seen in acute myocardial infarction with cardiogenic shock are known to be different and more acutely impaired than those presenting with ADHF‐CS as evidenced by differences in pressure/volume loops. Thus, data should not be extrapolated across these 2 very different disease processes. The aim of this review is to describe results from contemporary studies examining the use of IABPs as a bridge to dLVAD in patients with ADHF‐CS. Retrospective evidence from large registries suggests that the use of IABP as a bridge to dLVAD is feasible and safe when compared with other platforms of temporary mechanical circulatory support. However, there is currently a paucity of high‐quality evidence examining this increasingly important clinical question.

scholarly journals Invasive Hemodynamic Monitoring in Cardiogenic Shock Is Associated With Lower In‐Hospital Mortality

2021 ◽  
Author(s):  
Mohammed Osman ◽  
Moinuddin Syed ◽  
Brijesh Patel ◽  
Muhammad Bilal Munir ◽  
Babikir Kheiri ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Vascular Complications ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Invasive Hemodynamic Monitoring ◽  
Left Ventricular Assist

Background There is increasing utilization of cardiogenic shock treatment algorithms. The cornerstone of these algorithms is the use of invasive hemodynamic monitoring (IHM). We sought to compare the in‐hospital outcomes in patients who received IHM versus no IHM in a real‐world contemporary database. Methods and Results Patients with cardiogenic shock admitted during October 1, 2015 to December 31, 2018, were identified from the National Inpatient Sample. Among this group, we compared the outcomes among patients who received IHM versus no IHM. The primary end point was in‐hospital mortality. Secondary end points included vascular complications, major bleeding, need for renal replacement therapy, length of stay, cost of hospitalization, and rate of utilization of left ventricular assist devices and heart transplantation. Propensity score matching was used for covariate adjustment. A total of 394 635 (IHM=62 565; no IHM=332 070) patients were included. After propensity score matching, 2 well‐matched groups were compared (IHM=62 220; no IHM=62 220). The IHM group had lower in‐hospital mortality (24.1% versus 30.6%, P <0.01), higher percentages of left ventricular assist devices (4.4% versus 1.3%, P <0.01) and heart transplantation (1.3% versus 0.7%, P <0.01) utilization, longer length of hospitalization and higher costs. There was no difference between the 2 groups in terms of vascular complications, major bleeding, and the need for renal replacement therapy. Conclusions Among patients with cardiogenic shock, the use of IHM is associated with a reduction in in‐hospital mortality and increased utilization of advanced heart failure therapies. Due to the observational nature of the current study, the results should be considered hypothesis‐generating, and future prospective studies confirming these findings are needed.

Devices for Transcatheter Haemodynamic Support for Left Heart Failure

2010 ◽  
Vol 5 (1) ◽  
pp. 16
Author(s):  
Aman Ali ◽  
Timothy A Sanborn ◽  
◽  
Keyword(s):  
Mortality Rate ◽  
Cardiogenic Shock ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Severe Left Ventricular Dysfunction ◽  
Ventricular Assist ◽  
Left Heart Failure ◽  
Assist Devices ◽  
Left Ventricular Assist

Among patients with acute myocardial infarction (AMI), those in cardiogenic shock have the highest mortality rate. Early revascularisation with primary percutaneous intervention or coronary artery bypass surgery has decreased the mortality rate of patients in cardiogenic shock, but it remains high. The conventional treatment of haemodynamic instability has been the use of the intra-aortic balloon pump (IABP); however, the IABP may not give adequate support to patients with severe left ventricular dysfunction. Recent advances in percutaneous left ventricular assist devices, specifically the TandemHeart and Impella LP 2.5, have shown improved haemodynamic support compared with the IABP. This article provides an overview of the use of percutaneous left ventricular assist devices to treat patients presenting with cardiogenic shock after acute MI.

Aortic Regurgitation in Patients with Left Ventricular Assist Devices

2019 ◽  
pp. 338-344
Author(s):  
Marisa Cevasco ◽  
Koji Takeda ◽  
Masahiko Ando ◽  
Yoshifumi Naka
Keyword(s):  
Surgical Techniques ◽  
Treatment Strategies ◽  
Aortic Insufficiency ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Left Ventricular Assist

Aortic insufficiency (AI) occurs as a complication in 25% to 37% of cases that receive left ventricular assist devices (LVAD). The incidence increases after implant by 1% to 6% per month of continued support. Uncertainty remains over the appropriate management of pump speeds to help delay this deterioration (complete emptying versus allowing native ventricular function open the aortic on a regular basis). Significant AI can lead to hemodynamic impairment with adverse outcomes over time. Due to the recirculation of blood, the calculated cardiac output of the LVAD may be markedly skewed. A number of surgical techniques have been proposed for the prevention and management of AI in the setting of LVAD therapy. This chapter details the causes, treatment strategies, and outcomes associated with this complication.

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