HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Fincke, R. Search for Related Content PubMed PubMed Citation Articles by Fincke, R.

CLINICAL RESEARCH: CARDIOGENIC SHOCK

Cardiac power is the strongest hemodynamic correlate of mortality in cardiogenic shock: A report from the SHOCK trial registry

Rupert Fincke, MD^*,*, Judith S. Hochman, MD, FACC, April M. Lowe, MS, Venu Menon, MD, FACC, James N. Slater, MD, FACC, John G. Webb, MD, FACC^||, Thierry H. LeJemtel, MD, FACC^¶, Gad Cotter, MD, FACC^# SHOCK Investigators

^* New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York, USA
New York University School of Medicine, New York, New York, USA
New England Research Institutes, Watertown, Massachusetts, USA
University of North Carolina, Chapel Hill, North Carolina, USA
^|| St. Paul's Hospital, Vancouver, Canada
^¶ Albert Einstein College of Medicine, Bronx, New York, USA
^# Duke University Medical Center, Durham, North Carolina, USA

Manuscript received December 11, 2003; revised manuscript received March 8, 2004, accepted March 16, 2004.

^* Reprint requests and correspondence: Dr. Judith S. Hochman, New York University School of Medicine, 530 First Avenue, HCC 1173, New York, New York 10016, USA.
Judith.Hochman{at}med.nyu.edu

OBJECTIVES: We sought to analyze clinical, angiographic, and outcome correlates of hemodynamic parameters in cardiogenic shock.

BACKGROUND: The significance of right heart catheterization in critically ill patients is controversial, despite the prognostic importance of the derived measurements. Cardiac power is a novel hemodynamic parameter.

METHODS: A total of 541 patients with cardiogenic shock who were enrolled in the SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK (SHOCK) trial registry were included. Cardiac power output (CPO) (W) was calculated as mean arterial pressure x cardiac output/451.

RESULTS: On univariate analysis, CPO, cardiac power index (CPI), cardiac output, cardiac index, stroke volume, left ventricular work, left ventricular work index, stroke work, mean arterial pressure, systolic and diastolic blood pressure (all p < 0.001), coronary perfusion pressure (p = 0.002), ejection fraction (p = 0.013), and pulmonary artery systolic pressure (p = 0.047) were associated with in-hospital mortality. In separate multivariate analyses, CPO (odds ratio per 0.20 W: 0.60 [95% confidence interval, 0.44 to 0.83], p = 0.002; n = 181) and CPI (odds ratio per 0.10 W/m²: 0.65 [95% confidence interval, 0.48 to 0.87], p = 0.004; n = 178) remained the strongest independent hemodynamic correlates of in-hospital mortality after adjusting for age and history of hypertension. There was an inverse correlation between CPI and age (correlation coefficient: –0.334, p < 0.001). Women had a lower CPI than men (0.29 ± 0.11 vs. 0.35 ± 0.15 W/m², p = 0.005). After adjusting for age, female gender remained associated with CPI (p = 0.032).

CONCLUSIONS: Cardiac power is the strongest independent hemodynamic correlate of in-hospital mortality in patients with cardiogenic shock. Increasing age and female gender are independently associated with lower cardiac power.

Abbreviations and Acronyms   CI = cardiac index   CO = cardiac output   CPI = cardiac power index   CPO = cardiac power output   GUSTO-I = Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries-I   IABP = intra-aortic balloon pump   LV = left ventricle/ventricular   MI = myocardial infarction   PCWP = pulmonary capillary wedge pressure   RHC = right heart catheter   SHOCK = SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK   SVR = systemic vascular resistance

This article has been cited by other articles:

				H. R. Reynolds and J. S. Hochman Cardiogenic Shock: Current Concepts and Improving Outcomes Circulation, February 5, 2008; 117(5): 686 - 697. [Full Text] [PDF]

				R. V. Jeger, A. M. Lowe, C. E. Buller, M. E. Pfisterer, V. Dzavik, J. G. Webb, J. S. Hochman, U. P. Jorde, and for the SHOCK Investigators Hemodynamic Parameters Are Prognostically Important in Cardiogenic Shock But Similar Following Early Revascularization or Initial Medical Stabilization: A Report From the SHOCK Trial Chest, December 1, 2007; 132(6): 1794 - 1803. [Abstract] [Full Text] [PDF]

				The TRIUMPH Investigators Effect of Tilarginine Acetate in Patients With Acute Myocardial Infarction and Cardiogenic Shock: The TRIUMPH Randomized Controlled Trial JAMA, April 18, 2007; 297(15): 1657 - 1666. [Abstract] [Full Text] [PDF]

				J. S. Hochman, L. A. Sleeper, J. G. Webb, V. Dzavik, C. E. Buller, P. Aylward, J. Col, H. D. White, and for the SHOCK Investigators Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction. JAMA, June 7, 2006; 295(21): 2511 - 2515. [Abstract] [Full Text] [PDF]

				D. Chemla, I. Antony, K. Zamani, and A. Nitenberg Mean aortic pressure is the geometric mean of systolic and diastolic aortic pressure in resting humans J Appl Physiol, December 1, 2005; 99(6): 2278 - 2284. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members, S. Silber, P. Albertsson, F. F. Aviles, P. G. Camici, A. Colombo, C. Hamm, E. Jorgensen, J. Marco, J.-E. Nordrehaug, et al. Guidelines for Percutaneous Coronary Interventions: The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology Eur. Heart J., April 2, 2005; 26(8): 804 - 847. [Full Text] [PDF]

				Cardiac Power Output Predicts Death in Patients with Cardiogenic Shock Journal Watch Cardiology, October 8, 2004; 2004(1008): 6 - 6. [Full Text]