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Association between left ventricular ejection fraction, mortality and use of mechanical circulatory support in patients with non-ischaemic cardiogenic shock
J. Sundermeyer, C. Kellner, BN. Beer, L. Besch, A. Dettling, LF. Bertoldi, S. Blankenberg, J. Dauw, Z. Dindane, D. Eckner, I. Eitel, T. Graf, P. Horn, J. Jozwiak-Nozdrzykowska, P. Kirchhof, S. Kluge, A. Linke, U. Landmesser, P. Luedike, E....
Language English Country Germany
Document type Journal Article
NLK
ProQuest Central
from 2005-01-01 to 1 year ago
Medline Complete (EBSCOhost)
from 2000-08-01 to 1 year ago
Health & Medicine (ProQuest)
from 2005-01-01 to 1 year ago
- MeSH
- Ventricular Function, Left MeSH
- Shock, Cardiogenic * diagnosis therapy MeSH
- Middle Aged MeSH
- Humans MeSH
- Heart-Assist Devices * MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Stroke Volume MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
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.
Cardio Center Humanitas Clinical and Research Center IRCCS Rozzano Milan Italy
Department of Cardiology AZ Sint Lucas Ghent Belgium
Department of Cardiology Charité Universitätsmedizin Berlin Campus Benjamin Franklin Berlin Germany
Department of Cardiology IKEM Prague Czech Republic
Department of Cardiology Paracelsus Medical University Nürnberg Nuremberg Germany
Department of Intensive Care Medicine University Medical Center Hamburg Eppendorf Hamburg Germany
Department of Internal Medicine 1 University Hospital Jena Jena Germany
Department of Internal Medicine 1 University Hospital Würzburg Würzburg Germany
Department of Medicine 1 University Hospital LMU Munich Munich Germany
Department of Perioperative Medicine St Bartholomew's Hospital London UK
German Center for Cardiovascular Research Partner Site Hamburg Kiel Lübeck Hamburg Germany
Herzzentrum Dresden Technische Universität Dresden Dresden Germany
IRCCS S Maria Nascente Fondazione Don Carlo Gnocchi ONLUS Milan Italy
Medizinische Klinik 2 Kliniken Nordoberpfalz AG Weiden Germany
University Heart Center Lübeck University Hospital Schleswig Holstein Lübeck Germany
References provided by Crossref.org
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- $a Sundermeyer, Jonas $u Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany $u German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
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- $a Association between left ventricular ejection fraction, mortality and use of mechanical circulatory support in patients with non-ischaemic cardiogenic shock / $c J. Sundermeyer, C. Kellner, BN. Beer, L. Besch, A. Dettling, LF. Bertoldi, S. Blankenberg, J. Dauw, Z. Dindane, D. Eckner, I. Eitel, T. Graf, P. Horn, J. Jozwiak-Nozdrzykowska, P. Kirchhof, S. Kluge, A. Linke, U. Landmesser, P. Luedike, E. Lüsebrink, N. Majunke, N. Mangner, O. Maniuc, SM. Winkler, P. Nordbeck, M. Orban, F. Pappalardo, M. Pauschinger, M. Pazdernik, A. Proudfoot, M. Kelham, T. Rassaf, C. Scherer, PC. Schulze, RHG. Schwinger, C. Skurk, M. Sramko, G. Tavazzi, H. Thiele, L. Villanova, N. Morici, R. Westenfeld, EB. Winzer, D. Westermann, B. Schrage
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- $a 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.
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