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CLINICAL STUDY

The clinical profile of patients with suspected cardiogenic shock due to predominant left ventricular failure: a report from the SHOCK Trial Registry

Venu Menon, MD, FACC^*, Harvey White, DSc, FACC, Thierry LeJemtel, MD, FACC, John G. Webb, MD, FACC, Lynn A. Sleeper, ScD^||, Judith S. Hochman, MD, FACC^* for the SHOCK Investigators

^* Division of Cardiology, St. Luke’s–Roosevelt Hospital Center, Columbia University, New York, New York, USA
Division of Cardiology, Green Lane Hospital, Auckland, New Zealand
Division of Cardiology, Albert Einstein College of Medicine, Vancouver, British Columbia, Canada
Division of Cardiology, St. Paul’s Hospital, Vancouver, British Columbia, Canada
^|| New England Research Institutes, Watertown, Massachusetts, USA

Manuscript received February 16, 2000; revised manuscript received May 31, 2000, accepted June 7, 2000.

Reprint requests and correspondence: Dr. Venu Menon, FACC, St. Luke’s–Roosevelt Hospital Center, 1111 Amsterdam Avenue, New York, NY 10025
Vmenon{at}aol.com

Presented in part at the scientific sessions of the American Heart Association at Orlando in November 1997.

OBJECTIVES

We sought to evaluate the frequency of pulmonary congestion and associated clinical and hemodynamic findings in patients with suspected cardiogenic shock (CS).

BACKGROUND

The prevalence of pulmonary congestion in the setting of CS is uncertain.

METHODS

The 571 SHOCK Trial Registry patients with predominant left ventricular failure (LVF) were divided into four groups: Group A = no pulmonary congestion/no hypoperfusion = 14 (3%), Group B = isolated pulmonary congestion = 32 (6%), Group C = isolated hypoperfusion = 158 (28%) and Group D = congestion with hypoperfusion = 367 (64%). Statistical comparisons between Group C and D only, with regard to patient demographics, hemodynamics, treatment and outcome, were made.

RESULTS

A significant proportion of patients with shock had no pulmonary congestion (Group C = 28%, 95% CI, 24% to 31%). Age and gender in this group were similar to Group D. Group C patients were less likely to have a prior MI (p = 0.028), congestive heart failure (p = 0.005) and renal insufficiency (p = 0.032), and the index MI was less likely to be anterior (p = 0.044). Cardiac output, cardiac index and ejection fraction were similar for the two groups but pulmonary capillary wedge pressure was slightly lower for Group C (22 vs. 24 mm Hg, p = 0.012). Treatment with thrombolysis, angioplasty and bypass surgery was similar in the two groups. In-hospital mortality rates for Groups C and D were 70% and 60%, respectively (p = 0.036). After adjustment, this difference was no longer statistically significant (p = 0.153).

CONCLUSIONS

Absence of pulmonary congestion at initial clinical evaluation does not exclude a diagnosis of CS due to predominant LVF and is not associated with a better prognosis.

Abbreviations and Acronyms   AMI = acute myocardial infarction   BP = blood pressure   CS = cardiogenic shock   ECG = electrocardiogram, electrocardiographic   LVF = left ventricular failure   PC = pulmonary congestion   PCWP = pulmonary capillary wedge pressure   RHC = right heart catheterization   RV = right ventricular, right ventricle   SHOCK = SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK?

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