TY - JOUR
T1 - Association between left ventricular ejection fraction, mortality and use of mechanical circulatory support in patients with non-ischaemic cardiogenic shock
AU - Sundermeyer, Jonas
AU - Kellner, Caroline
AU - Beer, Benedikt N
AU - Besch, Lisa
AU - Dettling, Angela
AU - Bertoldi, Letizia Fausta
AU - Blankenberg, Stefan
AU - Dauw, Jeroen
AU - Dindane, Zouhir
AU - Eckner, Dennis
AU - Eitel, Ingo
AU - Graf, Tobias
AU - Horn, Patrick
AU - Jozwiak-Nozdrzykowska, Joanna
AU - Kirchhof, Paulus
AU - Kluge, Stefan
AU - Linke, Axel
AU - Landmesser, Ulf
AU - Luedike, Peter
AU - Lüsebrink, Enzo
AU - Majunke, Nicolas
AU - Mangner, Norman
AU - Maniuc, Octavian
AU - Winkler, Sven Möbius
AU - Nordbeck, Peter
AU - Orban, Martin
AU - Pappalardo, Federico
AU - Pauschinger, Matthias
AU - Pazdernik, Michal
AU - Proudfoot, Alastair
AU - Kelham, Matthew
AU - Rassaf, Tienush
AU - Scherer, Clemens
AU - Schulze, Paul Christian
AU - Schwinger, Robert H G
AU - Skurk, Carsten
AU - Sramko, Marek
AU - Tavazzi, Guido
AU - Thiele, Holger
AU - Villanova, Luca
AU - Morici, Nuccia
AU - Westenfeld, Ralf
AU - Winzer, Ephraim B
AU - Westermann, Dirk
AU - Schrage, Benedikt
N1 - Ecker, Pauschinger: Department of Cardiology, Paracelsus Medical University
Nürnberg, Nuremberg, Germany
PY - 2023/11/20
Y1 - 2023/11/20
N2 - BACKGROUND: Currently, use of mechanical circulatory support (MCS) in non-ischaemic cardiogenic shock (CS) is predominantly guided by shock-specific markers, and not by markers of cardiac function. We hypothesise that left ventricular ejection fraction (LVEF) can identify patients with a higher likelihood to benefit from MCS and thus help to optimise their expected benefit.METHODS: Patients with non-ischaemic CS and available data on LVEF from 16 tertiary-care centres in five countries were analysed. Cox regression models were fitted to evaluate the association between LVEF and mortality, as well as the interaction between LVEF, MCS use and mortality.RESULTS: N = 807 patients were analysed: mean age 63 [interquartile range (IQR) 51.5-72.0] years, 601 (74.5%) male, lactate 4.9 (IQR 2.6-8.5) mmol/l, LVEF 20 (IQR 15-30) %. Lower LVEF was more frequent amongst patients with more severe CS, and MCS was more likely used in patients with lower LVEF. There was no association between LVEF and 30-day mortality risk in the overall study cohort. However, there was a significant interaction between MCS use and LVEF, indicating a lower 30-day mortality risk with MCS use in patients with LVEF ≤ 20% (hazard ratio 0.72, 95% confidence interval 0.51-1.02 for LVEF ≤ 20% vs. hazard ratio 1.31, 95% confidence interval 0.85-2.01 for LVEF > 20%, interaction-p = 0.017).CONCLUSION: This retrospective study may indicate a lower mortality risk with MCS use only in patients with severely reduced LVEF. This may propose the inclusion of LVEF as an adjunctive parameter for MCS decision-making in non-ischaemic CS, aiming to optimise the benefit-risk ratio. Impact of left ventricular ejection fraction on mortality and use of mechanical circulatory support in non-ischaemic cardiogenic shock. Hazard ratio for 30-day mortality across the LVEF continuum, adjusted for age, sex, SCAI shock stage, worst value of lactate and pH within 6 h, prior resuscitation and mechanical ventilation during the index shock event. LVEF: Left ventricular ejection fraction; MCS: Mechanical circulatory support; HR: Hazard ratio; CI: Confidence interval.
AB - BACKGROUND: Currently, use of mechanical circulatory support (MCS) in non-ischaemic cardiogenic shock (CS) is predominantly guided by shock-specific markers, and not by markers of cardiac function. We hypothesise that left ventricular ejection fraction (LVEF) can identify patients with a higher likelihood to benefit from MCS and thus help to optimise their expected benefit.METHODS: Patients with non-ischaemic CS and available data on LVEF from 16 tertiary-care centres in five countries were analysed. Cox regression models were fitted to evaluate the association between LVEF and mortality, as well as the interaction between LVEF, MCS use and mortality.RESULTS: N = 807 patients were analysed: mean age 63 [interquartile range (IQR) 51.5-72.0] years, 601 (74.5%) male, lactate 4.9 (IQR 2.6-8.5) mmol/l, LVEF 20 (IQR 15-30) %. Lower LVEF was more frequent amongst patients with more severe CS, and MCS was more likely used in patients with lower LVEF. There was no association between LVEF and 30-day mortality risk in the overall study cohort. However, there was a significant interaction between MCS use and LVEF, indicating a lower 30-day mortality risk with MCS use in patients with LVEF ≤ 20% (hazard ratio 0.72, 95% confidence interval 0.51-1.02 for LVEF ≤ 20% vs. hazard ratio 1.31, 95% confidence interval 0.85-2.01 for LVEF > 20%, interaction-p = 0.017).CONCLUSION: This retrospective study may indicate a lower mortality risk with MCS use only in patients with severely reduced LVEF. This may propose the inclusion of LVEF as an adjunctive parameter for MCS decision-making in non-ischaemic CS, aiming to optimise the benefit-risk ratio. Impact of left ventricular ejection fraction on mortality and use of mechanical circulatory support in non-ischaemic cardiogenic shock. Hazard ratio for 30-day mortality across the LVEF continuum, adjusted for age, sex, SCAI shock stage, worst value of lactate and pH within 6 h, prior resuscitation and mechanical ventilation during the index shock event. LVEF: Left ventricular ejection fraction; MCS: Mechanical circulatory support; HR: Hazard ratio; CI: Confidence interval.
U2 - 10.1007/s00392-023-02332-y
DO - 10.1007/s00392-023-02332-y
M3 - Original Article (Journal)
C2 - 37982863
SN - 1861-0684
JO - CLINICAL RESEARCH IN CARDIOLOGY : OFFICIAL JOURNAL OF THE GERMAN CARDIAC SOCIETY
JF - CLINICAL RESEARCH IN CARDIOLOGY : OFFICIAL JOURNAL OF THE GERMAN CARDIAC SOCIETY
ER -