Prognostic value of right atrial pressure‐corrected cardiac power index in cardiogenic shock
Abstract Aim The pulmonary artery catheter (PAC)‐derived cardiac power index (CPI) has been found of prognostic value in cardiogenic shock (CS) patients. The original CPI equation included the right atrial pressure (RAP), accounting for heart filling pressure as a determinant of systolic myocardial...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-12-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.14093 |
| _version_ | 1797979215794012160 |
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| author | Luca Baldetti Matteo Pagnesi Guglielmo Gallone Giuseppe Barone Nicolai Fierro Francesco Calvo Mario Gramegna Vittorio Pazzanese Angela Venuti Stefania Sacchi Gaetano Maria De Ferrari Daniel Burkhoff Hoong Sern Lim Alberto Maria Cappelletti |
| author_facet | Luca Baldetti Matteo Pagnesi Guglielmo Gallone Giuseppe Barone Nicolai Fierro Francesco Calvo Mario Gramegna Vittorio Pazzanese Angela Venuti Stefania Sacchi Gaetano Maria De Ferrari Daniel Burkhoff Hoong Sern Lim Alberto Maria Cappelletti |
| author_sort | Luca Baldetti |
| collection | DOAJ |
| description | Abstract Aim The pulmonary artery catheter (PAC)‐derived cardiac power index (CPI) has been found of prognostic value in cardiogenic shock (CS) patients. The original CPI equation included the right atrial pressure (RAP), accounting for heart filling pressure as a determinant of systolic myocardial work, but this term was subsequently omitted. We hypothesized that the original CPI formula (CPIRAP) is superior to current CPI for risk stratification in CS. Methods and results A single‐centre cohort of 80 consecutive Society for Cardiovascular Angiography and Interventions (SCAI) B‐D CS patients with available PAC records was included. Overall in‐hospital mortality was 21.3%. Results showed CPIRAP to be the strongest haemodynamic predictor of in‐hospital death (padj = 0.038), outperforming CPI [area under the receiver operating characteristic (ROC) curves: 0.726 and 0.673, P‐for‐difference = 0.025]. When the population was stratified according to the identified CPIRAP (0.28 W/m2) and accepted CPI (0.32 W/m2) thresholds, the cohort with discordant indexes (low CPIRAP and high CPI) comprised a group of 13 patients featuring a congested phenotype with frequent right ventricle or biventricular involvement. In this group, in‐hospital mortality was high (30.8%) similar to those with concordant low CPI and CPIRAP. Conclusion Incorporating RAP in CPI calculation (CPIRAP) improves the prognostic yield in patients with CS SCAI B‐D. A cut‐off of 0.28 W/m2 identifies patients at higher risk of in‐hospital mortality. The improved prognostic value of CPIRAP may derive from identification of patients with more intravascular congestion who may experience substantial in‐hospital mortality, uncaptured by the commonly used CPI equation. |
| first_indexed | 2024-04-11T05:35:23Z |
| format | Article |
| id | doaj.art-07c0be6a7ac34a3c9a51901793b6371c |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-04-11T05:35:23Z |
| publishDate | 2022-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-07c0be6a7ac34a3c9a51901793b6371c2022-12-22T12:55:33ZengWileyESC Heart Failure2055-58222022-12-01963920393010.1002/ehf2.14093Prognostic value of right atrial pressure‐corrected cardiac power index in cardiogenic shockLuca Baldetti0Matteo Pagnesi1Guglielmo Gallone2Giuseppe Barone3Nicolai Fierro4Francesco Calvo5Mario Gramegna6Vittorio Pazzanese7Angela Venuti8Stefania Sacchi9Gaetano Maria De Ferrari10Daniel Burkhoff11Hoong Sern Lim12Alberto Maria Cappelletti13Cardiac Intensive Care Unit IRCCS San Raffaele Scientific Institute Milan ItalyInstitute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia Brescia ItalyCardiac Intensive Care Unit IRCCS San Raffaele Scientific Institute Milan ItalyCardiac Intensive Care Unit IRCCS San Raffaele Scientific Institute Milan ItalyCardiac Intensive Care Unit IRCCS San Raffaele Scientific Institute Milan ItalyCardiac Intensive Care Unit IRCCS San Raffaele Scientific Institute Milan ItalyCardiac Intensive Care Unit IRCCS San Raffaele Scientific Institute Milan ItalyCardiac Intensive Care Unit IRCCS San Raffaele Scientific Institute Milan ItalyCardiac Intensive Care Unit IRCCS San Raffaele Scientific Institute Milan ItalyCardiac Intensive Care Unit IRCCS San Raffaele Scientific Institute Milan ItalyDivision of Cardiology Città della Salute e della Scienza University Hospital of Turin Turin ItalyCardiovascular Research Foundation New York USAUniversity Hospital Birmingham NHS Foundation Trust Edgbaston Birmingham UKCardiac Intensive Care Unit IRCCS San Raffaele Scientific Institute Milan ItalyAbstract Aim The pulmonary artery catheter (PAC)‐derived cardiac power index (CPI) has been found of prognostic value in cardiogenic shock (CS) patients. The original CPI equation included the right atrial pressure (RAP), accounting for heart filling pressure as a determinant of systolic myocardial work, but this term was subsequently omitted. We hypothesized that the original CPI formula (CPIRAP) is superior to current CPI for risk stratification in CS. Methods and results A single‐centre cohort of 80 consecutive Society for Cardiovascular Angiography and Interventions (SCAI) B‐D CS patients with available PAC records was included. Overall in‐hospital mortality was 21.3%. Results showed CPIRAP to be the strongest haemodynamic predictor of in‐hospital death (padj = 0.038), outperforming CPI [area under the receiver operating characteristic (ROC) curves: 0.726 and 0.673, P‐for‐difference = 0.025]. When the population was stratified according to the identified CPIRAP (0.28 W/m2) and accepted CPI (0.32 W/m2) thresholds, the cohort with discordant indexes (low CPIRAP and high CPI) comprised a group of 13 patients featuring a congested phenotype with frequent right ventricle or biventricular involvement. In this group, in‐hospital mortality was high (30.8%) similar to those with concordant low CPI and CPIRAP. Conclusion Incorporating RAP in CPI calculation (CPIRAP) improves the prognostic yield in patients with CS SCAI B‐D. A cut‐off of 0.28 W/m2 identifies patients at higher risk of in‐hospital mortality. The improved prognostic value of CPIRAP may derive from identification of patients with more intravascular congestion who may experience substantial in‐hospital mortality, uncaptured by the commonly used CPI equation.https://doi.org/10.1002/ehf2.14093Cardiac power indexCPICardiac power outputCardiogenic shockPulmonary artery catheterHaemodynamic monitoring |
| spellingShingle | Luca Baldetti Matteo Pagnesi Guglielmo Gallone Giuseppe Barone Nicolai Fierro Francesco Calvo Mario Gramegna Vittorio Pazzanese Angela Venuti Stefania Sacchi Gaetano Maria De Ferrari Daniel Burkhoff Hoong Sern Lim Alberto Maria Cappelletti Prognostic value of right atrial pressure‐corrected cardiac power index in cardiogenic shock ESC Heart Failure Cardiac power index CPI Cardiac power output Cardiogenic shock Pulmonary artery catheter Haemodynamic monitoring |
| title | Prognostic value of right atrial pressure‐corrected cardiac power index in cardiogenic shock |
| title_full | Prognostic value of right atrial pressure‐corrected cardiac power index in cardiogenic shock |
| title_fullStr | Prognostic value of right atrial pressure‐corrected cardiac power index in cardiogenic shock |
| title_full_unstemmed | Prognostic value of right atrial pressure‐corrected cardiac power index in cardiogenic shock |
| title_short | Prognostic value of right atrial pressure‐corrected cardiac power index in cardiogenic shock |
| title_sort | prognostic value of right atrial pressure corrected cardiac power index in cardiogenic shock |
| topic | Cardiac power index CPI Cardiac power output Cardiogenic shock Pulmonary artery catheter Haemodynamic monitoring |
| url | https://doi.org/10.1002/ehf2.14093 |
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