Invasive Phenoprofiling of Acute-Myocardial-Infarction-Related Cardiogenic Shock
Background: Studies had previously identified three cardiogenic shock (CS) phenotypes (cardiac-only, cardiorenal, and cardiometabolic). Therefore, we aimed to understand better the hemodynamic profiles of these phenotypes in acute myocardial infarction-CS (AMI-CS) using pulmonary artery catheter (PA...
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| Format: | Article |
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MDPI AG
2023-09-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/18/5818 |
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| author | Jorge A. Ortega-Hernández Héctor González-Pacheco Jardiel Argüello-Bolaños José Omar Arenas-Díaz Roberto Pérez-López Mario Ramón García-Arias Rodrigo Gopar-Nieto Daniel Sierra-Lara-Martínez Diego Araiza-Garaygordobil Daniel Manzur-Sandoval Luis Alejandro Soliz-Uriona Gloria Monserrath Astudillo-Alvarez Jaime Hernández-Montfort Alexandra Arias-Mendoza |
| author_facet | Jorge A. Ortega-Hernández Héctor González-Pacheco Jardiel Argüello-Bolaños José Omar Arenas-Díaz Roberto Pérez-López Mario Ramón García-Arias Rodrigo Gopar-Nieto Daniel Sierra-Lara-Martínez Diego Araiza-Garaygordobil Daniel Manzur-Sandoval Luis Alejandro Soliz-Uriona Gloria Monserrath Astudillo-Alvarez Jaime Hernández-Montfort Alexandra Arias-Mendoza |
| author_sort | Jorge A. Ortega-Hernández |
| collection | DOAJ |
| description | Background: Studies had previously identified three cardiogenic shock (CS) phenotypes (cardiac-only, cardiorenal, and cardiometabolic). Therefore, we aimed to understand better the hemodynamic profiles of these phenotypes in acute myocardial infarction-CS (AMI-CS) using pulmonary artery catheter (PAC) data to better understand the AMI-CS heterogeneity. Methods: We analyzed the PAC data of 309 patients with AMI-CS. The patients were classified by SCAI shock stage, congestion profile, and phenotype. In addition, 24 h hemodynamic PAC data were obtained. Results: We identified three AMI-CS phenotypes: cardiac-only (43.7%), cardiorenal (32.0%), and cardiometabolic (24.3%). The cardiometabolic phenotype had the highest mortality rate (70.7%), followed by the cardiorenal (52.5%) and cardiac-only (33.3%) phenotypes, with significant differences (<i>p</i> < 0.001). Right atrial pressure (<i>p</i> = 0.001) and pulmonary capillary wedge pressure (<i>p</i> = 0.01) were higher in the cardiometabolic and cardiorenal phenotypes. Cardiac output, index, power, power index, and cardiac power index normalized by right atrial pressure and left-ventricular stroke work index were lower in the cardiorenal and cardiometabolic than in the cardiac-only phenotypes. We found a hazard ratio (HR) of 2.1 for the cardiorenal and 3.3 for cardiometabolic versus the cardiac-only phenotypes (<i>p</i> < 0.001). Also, multi-organ failure, acute kidney injury, and ventricular tachycardia/fibrillation had a significant HR. Multivariate analysis revealed that CS phenotypes retained significance (<i>p</i> < 0.001) when adjusted for the Society for Cardiovascular Angiography & Interventions score (<i>p</i> = 0.011) and ∆congestion (<i>p</i> = 0.028). These scores independently predicted mortality. Conclusions: Accurate patient prognosis and treatment strategies are crucial, and phenotyping in AMI-CS can aid in this effort. PAC profiling can provide valuable prognostic information and help design new trials involving AMI-CS. |
| first_indexed | 2024-03-10T22:36:53Z |
| format | Article |
| id | doaj.art-150d00c282094e7aba8c93cc45950e86 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T22:36:53Z |
| publishDate | 2023-09-01 |
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| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-150d00c282094e7aba8c93cc45950e862023-11-19T11:17:47ZengMDPI AGJournal of Clinical Medicine2077-03832023-09-011218581810.3390/jcm12185818Invasive Phenoprofiling of Acute-Myocardial-Infarction-Related Cardiogenic ShockJorge A. Ortega-Hernández0Héctor González-Pacheco1Jardiel Argüello-Bolaños2José Omar Arenas-Díaz3Roberto Pérez-López4Mario Ramón García-Arias5Rodrigo Gopar-Nieto6Daniel Sierra-Lara-Martínez7Diego Araiza-Garaygordobil8Daniel Manzur-Sandoval9Luis Alejandro Soliz-Uriona10Gloria Monserrath Astudillo-Alvarez11Jaime Hernández-Montfort12Alexandra Arias-Mendoza13Instituto Nacional de Cardiología Ignacio Chávez, Coronary Care Unit, Juan Badiano 1, Sección XVI, Tlalpan, Ciudad De Mexico 14080, MexicoInstituto Nacional de Cardiología Ignacio Chávez, Coronary Care Unit, Juan Badiano 1, Sección XVI, Tlalpan, Ciudad De Mexico 14080, MexicoInstituto Nacional de Cardiología Ignacio Chávez, Coronary Care Unit, Juan Badiano 1, Sección XVI, Tlalpan, Ciudad De Mexico 14080, MexicoInstituto Nacional de Cardiología Ignacio Chávez, Coronary Care Unit, Juan Badiano 1, Sección XVI, Tlalpan, Ciudad De Mexico 14080, MexicoInstituto Nacional de Cardiología Ignacio Chávez, Coronary Care Unit, Juan Badiano 1, Sección XVI, Tlalpan, Ciudad De Mexico 14080, MexicoInstituto Nacional de Cardiología Ignacio Chávez, Coronary Care Unit, Juan Badiano 1, Sección XVI, Tlalpan, Ciudad De Mexico 14080, MexicoInstituto Nacional de Cardiología Ignacio Chávez, Coronary Care Unit, Juan Badiano 1, Sección XVI, Tlalpan, Ciudad De Mexico 14080, MexicoInstituto Nacional de Cardiología Ignacio Chávez, Coronary Care Unit, Juan Badiano 1, Sección XVI, Tlalpan, Ciudad De Mexico 14080, MexicoInstituto Nacional de Cardiología Ignacio Chávez, Coronary Care Unit, Juan Badiano 1, Sección XVI, Tlalpan, Ciudad De Mexico 14080, MexicoInstituto Nacional de Cardiología Ignacio Chávez, Coronary Care Unit, Juan Badiano 1, Sección XVI, Tlalpan, Ciudad De Mexico 14080, MexicoInstituto Nacional de Cardiología Ignacio Chávez, Coronary Care Unit, Juan Badiano 1, Sección XVI, Tlalpan, Ciudad De Mexico 14080, MexicoInstituto Nacional de Cardiología Ignacio Chávez, Coronary Care Unit, Juan Badiano 1, Sección XVI, Tlalpan, Ciudad De Mexico 14080, MexicoAdvanced Heart Failure and Recovery Program for Central Texas Baylor Scott & White Health, 302 University Blvd, Round Rock, TX 78665, USAInstituto Nacional de Cardiología Ignacio Chávez, Coronary Care Unit, Juan Badiano 1, Sección XVI, Tlalpan, Ciudad De Mexico 14080, MexicoBackground: Studies had previously identified three cardiogenic shock (CS) phenotypes (cardiac-only, cardiorenal, and cardiometabolic). Therefore, we aimed to understand better the hemodynamic profiles of these phenotypes in acute myocardial infarction-CS (AMI-CS) using pulmonary artery catheter (PAC) data to better understand the AMI-CS heterogeneity. Methods: We analyzed the PAC data of 309 patients with AMI-CS. The patients were classified by SCAI shock stage, congestion profile, and phenotype. In addition, 24 h hemodynamic PAC data were obtained. Results: We identified three AMI-CS phenotypes: cardiac-only (43.7%), cardiorenal (32.0%), and cardiometabolic (24.3%). The cardiometabolic phenotype had the highest mortality rate (70.7%), followed by the cardiorenal (52.5%) and cardiac-only (33.3%) phenotypes, with significant differences (<i>p</i> < 0.001). Right atrial pressure (<i>p</i> = 0.001) and pulmonary capillary wedge pressure (<i>p</i> = 0.01) were higher in the cardiometabolic and cardiorenal phenotypes. Cardiac output, index, power, power index, and cardiac power index normalized by right atrial pressure and left-ventricular stroke work index were lower in the cardiorenal and cardiometabolic than in the cardiac-only phenotypes. We found a hazard ratio (HR) of 2.1 for the cardiorenal and 3.3 for cardiometabolic versus the cardiac-only phenotypes (<i>p</i> < 0.001). Also, multi-organ failure, acute kidney injury, and ventricular tachycardia/fibrillation had a significant HR. Multivariate analysis revealed that CS phenotypes retained significance (<i>p</i> < 0.001) when adjusted for the Society for Cardiovascular Angiography & Interventions score (<i>p</i> = 0.011) and ∆congestion (<i>p</i> = 0.028). These scores independently predicted mortality. Conclusions: Accurate patient prognosis and treatment strategies are crucial, and phenotyping in AMI-CS can aid in this effort. PAC profiling can provide valuable prognostic information and help design new trials involving AMI-CS.https://www.mdpi.com/2077-0383/12/18/5818acute myocardial infarctioncardiogenic shockpulmonary artery catheterhemodynamic profilesCS phenotypescongestion profiling |
| spellingShingle | Jorge A. Ortega-Hernández Héctor González-Pacheco Jardiel Argüello-Bolaños José Omar Arenas-Díaz Roberto Pérez-López Mario Ramón García-Arias Rodrigo Gopar-Nieto Daniel Sierra-Lara-Martínez Diego Araiza-Garaygordobil Daniel Manzur-Sandoval Luis Alejandro Soliz-Uriona Gloria Monserrath Astudillo-Alvarez Jaime Hernández-Montfort Alexandra Arias-Mendoza Invasive Phenoprofiling of Acute-Myocardial-Infarction-Related Cardiogenic Shock Journal of Clinical Medicine acute myocardial infarction cardiogenic shock pulmonary artery catheter hemodynamic profiles CS phenotypes congestion profiling |
| title | Invasive Phenoprofiling of Acute-Myocardial-Infarction-Related Cardiogenic Shock |
| title_full | Invasive Phenoprofiling of Acute-Myocardial-Infarction-Related Cardiogenic Shock |
| title_fullStr | Invasive Phenoprofiling of Acute-Myocardial-Infarction-Related Cardiogenic Shock |
| title_full_unstemmed | Invasive Phenoprofiling of Acute-Myocardial-Infarction-Related Cardiogenic Shock |
| title_short | Invasive Phenoprofiling of Acute-Myocardial-Infarction-Related Cardiogenic Shock |
| title_sort | invasive phenoprofiling of acute myocardial infarction related cardiogenic shock |
| topic | acute myocardial infarction cardiogenic shock pulmonary artery catheter hemodynamic profiles CS phenotypes congestion profiling |
| url | https://www.mdpi.com/2077-0383/12/18/5818 |
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