Diastolic Perfusion Pressure Predicts Response to Inotropes and Vasopressors and Benefit From Mechanical Circulatory Support in Cardiogenic Shock

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00669806%3A_____%2F25%3A10498036" target="_blank" >RIV/00669806:_____/25:10498036 - isvavai.cz</a>

Nalezeny alternativní kódy

RIV/00216208:11110/25:10498036 RIV/00216208:11130/25:10498036 RIV/00216208:11140/25:10498036 RIV/00064203:_____/25:10498036 RIV/00064165:_____/25:10498036

Výsledek na webu

<a href="https://verso.is.cuni.cz/pub/verso.fpl?fname=obd_publikace_handle&handle=esiWUxN04H" target="_blank" >https://verso.is.cuni.cz/pub/verso.fpl?fname=obd_publikace_handle&handle=esiWUxN04H</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1161/CIRCHEARTFAILURE.125.012847" target="_blank" >10.1161/CIRCHEARTFAILURE.125.012847</a>

Jazyk výsledku

angličtina

Název v původním jazyce

Diastolic Perfusion Pressure Predicts Response to Inotropes and Vasopressors and Benefit From Mechanical Circulatory Support in Cardiogenic Shock

Popis výsledku v původním jazyce

BACKGROUND: Hemodynamic response to escalation of vasoactive drugs has not been well-characterized in patients with cardiogenic shock (CS). We tested the hypothesis that lower diastolic perfusion pressure (DPP=diastolic blood pressure-right atrial pressure) was associated with more limited hemodynamic response to uptitration of vasoactive drugs and with possible benefit from early mechanical circulatory support in patients with CS. METHODS: This study consisted of 2 parts: (1) we evaluated the relationship between baseline DPP and changes in cardiac power output index (CPOI) in response to increase in vasoactive drugs in a cohort of patients with CS (n=93) and (2) we compared all-cause mortality based on baseline DPP in a post hoc analysis of the ECMO-CS trial (Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock). CPOI responders were defined as postescalation CPOI &gt;=0.28 W/m(2). RESULTS: Vasoactive inotrope score escalated from 11.2+-3.9 to 24.5+-4.7. Escalation of vasoactive drugs was associated with increases in CPOI to 0.23+-0.06 W/m(2) (all P&lt;0.001). Postescalation CPOI was directly related to baseline cardiac index and DPP. Baseline DPP discriminated CPO responders from nonresponders with an optimal cutoff of 37 mm Hg. Patients with baseline DPP &gt;=37 mm Hg had greater CPOI increase and lactate clearance. In the ECMO-CS trial, patients with DPP &lt;37 mm Hg had lower mortality (hazard ratio, 0.37 [95% CI, 0.14-0.97]; P=0.044) with immediate venoarterial extracorporeal membrane oxygenation compared with early conservative management but no significant difference in the subgroup with DPP &gt;=37 mm Hg. CONCLUSIONS: Lower DPP was associated with more limited hemodynamic response to escalation of vasoactive drugs and potentially greater benefit from early venoarterial extracorporeal membrane oxygenation in CS.

Název v anglickém jazyce

Diastolic Perfusion Pressure Predicts Response to Inotropes and Vasopressors and Benefit From Mechanical Circulatory Support in Cardiogenic Shock

Popis výsledku anglicky

BACKGROUND: Hemodynamic response to escalation of vasoactive drugs has not been well-characterized in patients with cardiogenic shock (CS). We tested the hypothesis that lower diastolic perfusion pressure (DPP=diastolic blood pressure-right atrial pressure) was associated with more limited hemodynamic response to uptitration of vasoactive drugs and with possible benefit from early mechanical circulatory support in patients with CS. METHODS: This study consisted of 2 parts: (1) we evaluated the relationship between baseline DPP and changes in cardiac power output index (CPOI) in response to increase in vasoactive drugs in a cohort of patients with CS (n=93) and (2) we compared all-cause mortality based on baseline DPP in a post hoc analysis of the ECMO-CS trial (Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock). CPOI responders were defined as postescalation CPOI &gt;=0.28 W/m(2). RESULTS: Vasoactive inotrope score escalated from 11.2+-3.9 to 24.5+-4.7. Escalation of vasoactive drugs was associated with increases in CPOI to 0.23+-0.06 W/m(2) (all P&lt;0.001). Postescalation CPOI was directly related to baseline cardiac index and DPP. Baseline DPP discriminated CPO responders from nonresponders with an optimal cutoff of 37 mm Hg. Patients with baseline DPP &gt;=37 mm Hg had greater CPOI increase and lactate clearance. In the ECMO-CS trial, patients with DPP &lt;37 mm Hg had lower mortality (hazard ratio, 0.37 [95% CI, 0.14-0.97]; P=0.044) with immediate venoarterial extracorporeal membrane oxygenation compared with early conservative management but no significant difference in the subgroup with DPP &gt;=37 mm Hg. CONCLUSIONS: Lower DPP was associated with more limited hemodynamic response to escalation of vasoactive drugs and potentially greater benefit from early venoarterial extracorporeal membrane oxygenation in CS.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30201 - Cardiac and Cardiovascular systems

Projekt

<a href="/cs/project/NV15-27994A" target="_blank" >NV15-27994A: Extrakorporální membránová oxygenace v léčbě kardiogenního šoku (studie ECMO-CS)</a><br>

Návaznosti

P - Projekt vyzkumu a vyvoje financovany z verejnych zdroju (s odkazem do CEP)<br>I - Institucionalni podpora na dlouhodoby koncepcni rozvoj vyzkumne organizace

Rok uplatnění

2025

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Název periodika

Circulation: Heart Failure

ISSN

1941-3289

e-ISSN

1941-3297

Svazek periodika

18

Číslo periodika v rámci svazku

7

Stát vydavatele periodika

US - Spojené státy americké

Počet stran výsledku

9

Strana od-do

e012847

Kód UT WoS článku

001525800900001

EID výsledku v databázi Scopus

2-s2.0-105005463761