Doppler-derived haemodynamics performed during admission echocardiography predict in-hospital mortality in cardiac intensive care unit patients

Jentzer, Jacob C.; Tabi, Meir; Wiley, Brandon M.; Lanspa, Michael J.; Anavekar, Nandan S.; Oh, Jae K.

doi:10.1093/ehjacc/zuac084

Cited by 12 publications

(12 citation statements)

References 36 publications

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“… 11 Furthermore, we moved beyond the simple 2‐dimensional assessment of biventricular function to show that easily obtained Doppler measurements reflecting intrinsic cardiac systolic and diastolic function could provide a more nuanced prognostication strategy. 12 , 13 , 14 , 15 , 16 , 17 …”

Section: Discussionmentioning

confidence: 99%

“…As demonstrated in our prior analyses, Doppler hemodynamic measurements based on the LV outflow tract velocity‐time integral (reflecting forward flow) carry powerful prognostic information and should be routinely measured in CICU patients. 12 , 13 , 14 , 16 , 17 , 20 , 21 Although less predictive for patients with established shock, the mitral E/e’ ratio (reflecting LV diastolic function and filling pressures) is another important predictor of mortality in CICU patients that can be easily obtained at the bedside. 13 , 17 , 21 The LVSWI combines both of these measurements and appeared to provide robust risk stratification in each clinical shock subgroup with marked separation between high‐ and low‐risk groups (Figure 4 ).…”

Section: Discussionmentioning

confidence: 99%

“… 12 , 13 , 14 , 16 , 17 , 20 , 21 Although less predictive for patients with established shock, the mitral E/e’ ratio (reflecting LV diastolic function and filling pressures) is another important predictor of mortality in CICU patients that can be easily obtained at the bedside. 13 , 17 , 21 The LVSWI combines both of these measurements and appeared to provide robust risk stratification in each clinical shock subgroup with marked separation between high‐ and low‐risk groups (Figure 4 ). 12 , 14 More important, our analysis identified several established and novel TTE variables that might also be used for risk stratification, depending on which TTE data can be obtained at bedside.…”

Section: Discussionmentioning

confidence: 99%

“…The Mayo Clinic Echocardiography Database was queried, and data were extracted from the TTE performed closest to CICU admission, including vital signs at the time of TTE and echocardiographic variables of interest (Table S2 ). 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 One best LVEF value for each patient was determined using a hierarchical approach: volumetric LVEF calculated using Simpson biplane method was preferred, followed by monoplane volumetric approach, quantitative linear methods, and finally visual estimation if these other methods were unavailable; the specific method of LVEF measurement could not be determined for each patient. 11 , 28 The LV systolic dysfunction was classified as mild, moderate, and severe based on sex‐specific American Society of Echocardiography cutoffs for LVEF.…”

Section: Methodsmentioning

confidence: 99%

“… 11 , 12 , 13 TTE, including noninvasive Doppler hemodynamic assessment, can therefore be additive in the assessment of shock severity for prognostication and decision‐making in CICU patients. 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 …”

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confidence: 99%

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Noninvasive Hemodynamic Characterization of Shock and Preshock Using Echocardiography in Cardiac Intensive Care Unit Patients

Jentzer,

Burstein,

Ternus

et al. 2023

JAHA

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Background Shock and preshock are defined on the basis of the presence of hypotension, hypoperfusion, or both. We sought to determine the hemodynamic underpinnings of shock and preshock noninvasively using transthoracic echocardiography (TTE). Methods and Results We included Mayo Clinic cardiac intensive care unit patients from 2007 to 2015 with TTE within 1 day of admission. Hypotension and hypoperfusion at the time of cardiac intensive care unit admission were used to define 4 groups. TTE findings were evaluated across these groups, and in‐hospital mortality was evaluated according to TTE findings in each group. We included 5375 patients with a median age of 69.2 years (36.8% women). The median left ventricular ejection fraction was 50%. Groups based on hypotension and hypoperfusion were assigned as follows: no hypotension or hypoperfusion, 59.7%; isolated hypotension, 15.3%; isolated hypoperfusion, 16.4%; and both hypotension and hypoperfusion, 8.7%. Most TTE variables of interest varied across these groups, with worse biventricular function, lower forward flow, and higher filling pressures as the degree of hemodynamic compromise increased. In‐hospital mortality occurred in 8.2%, and inpatient deaths had more TTE parameter abnormalities. In‐hospital mortality increased with the degree of hemodynamic compromise, and a marked gradient in in‐hospital mortality was observed when the clinical classification of shock and preshock was combined with TTE findings reflecting worse biventricular function, lower forward flow, or higher filling pressures. Conclusions Substantial differences in cardiac function are observed between cardiac intensive care unit patients with preshock and shock using TTE, and the combination of the clinical and TTE hemodynamic assessment provides robust mortality risk stratification.

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