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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

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