The prognostic value of pulmonary artery compliance in cardiogenic shock.

Details

Serval ID
serval:BIB_51A9B28736A8
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
The prognostic value of pulmonary artery compliance in cardiogenic shock.
Journal
Pulmonary circulation
Author(s)
Zorzi M.F., Cancelli E., Rusca M., Kirsch M., Yerly P., Liaudet L.
ISSN
2045-8932 (Print)
ISSN-L
2045-8932
Publication state
Published
Issued date
2019
Peer-reviewed
Oui
Volume
9
Number
3
Pages
2045894019877161
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
The aim of this study was to evaluate the pathophysiological role and the prognostic significance of pulmonary artery compliance (C <sub>PA</sub> ), a measure of right ventricular pulsatile afterload, in cardiogenic shock. We retrospectively included 91 consecutive patients with cardiogenic shock due to primary left ventricular failure, monitored with a pulmonary artery catheter within the first 24 h. C <sub>PA</sub> was calculated as the ratio of stroke volume to pulmonary artery pulse pressure, and we determined whether C <sub>PA</sub> predicted mortality and whether it performed better than other pulmonary hemodynamic variables. The overall in-hospital mortality in our cohort was 27%. Survivors and nonsurvivors had comparable left ventricular ejection fraction, systolic, diastolic and mean pulmonary artery pressure, transpulmonary gradient, diastolic pressure gradient, and pulmonary vascular resistance at 24 h. In contrast, C <sub>PA</sub> was the only pulmonary artery variable significantly associated with mortality in univariate and multivariate analyses. Mortality increased from 4.5% at the highest quartile of C <sub>PA</sub> (3.6-6.5 mL/mmHg) to 43.5% at the lowest quartile (0.7-1.7 mL/mmHg). In 64 patients with a PAC inserted immediately upon admission, we calculated the trend of C <sub>PA</sub> between admission and 24 h. This trend was positive in survivors (+0.8 ± 1.3 ml/mmHg) but negative in nonsurvivors (-0.1 ± 1.0 mL/mmHg). The lower C <sub>PA</sub> in nonsurvivors was associated with more severe right ventricular systolic dysfunction. In conclusion, a reduced compliance of the pulmonary artery promotes right ventricular dysfunction and is independently associated with mortality in cardiogenic shock. Future studies should evaluate the impact on pulmonary arterial compliance and right ventricular afterload of therapies used in cardiogenic shock.
Keywords
cardiac output, cardiopulmonary physiology and pathophysiology, hemodynamics, pulmonary circulation
Pubmed
Web of science
Open Access
Yes
Create date
09/10/2019 12:42
Last modification date
26/11/2020 6:26
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