Measurement of cardiac reserve in cardiogenic shock: implications for prognosis and management.

L B Tan, W A Littler

Department of Cardiovascular Medicine, University of Birmingham, East Birmingham Hospital.

The hypothesis that the prognosis of cardiogenic shock patients is primarily dependent on cardiac pumping reserve was tested in a prospective study of 28 consecutive patients clinically diagnosed to be in cardiogenic shock and treated medically. Haemodynamic function was assessed by thermodilution Swan-Ganz catheters and arterial cannulas. The cardiac pumping reserve was evaluated by the response of the failing heart to graded incremental dobutamine infusion (2.5 to 40 micrograms/kg/min) after optimalising the left ventricular preload. Eleven of the patients survived for more than the one year of follow up and the rest died. Haemodynamic evaluation during the basal resting state was only able to identify unambiguously non-survivors whose cardiac function was most severely compromised. Survivors and non-survivors with higher values were indistinguishable by basal haemodynamic criteria. The response to dobutamine stimulation clearly separated the cardiac pump function of survivors and those who died. All patients with peak cardiac power output of less than 1.0 W or peak left ventricular stroke work index of less than 0.25 J/m2 died whereas all those with higher values lived for more than a year. Thus this study showed that haemodynamic evaluation of cardiac reserve can provide objective criteria for predicting outcome in individual patients with cardiogenic shock. The availability of such a prognostic indicator will be invaluable in formulating management plans for these patients.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Corra, U., Mezzani, A., Giordano, A., Bosimini, E., Giannuzzi, P. (2009). Exercise haemodynamic variables rather than ventilatory efficiency indexes contribute to risk assessment in chronic heart failure patients treated with carvedilol. Eur Heart J 0: ehp138v1-ehp138 [Abstract] [Full Text]  
• Garcia-Gonzalez, M. J., Dominguez-Rodriguez, A., Ferrer-Hita, J. J., Abreu-Gonzalez, P., Munoz, M. B. (2006). Cardiogenic shock after primary percutaneous coronary intervention: Effects of levosimendan compared with dobutamine on haemodynamics. Eur J Heart Fail 8: 723-728 [Abstract] [Full Text]  
• Otasevic, P, Popovic, Z B, Vasiljevic, J D, Pratali, L, Vlahovic-Stipac, A, Boskovic, S D, Tasic, N, Neskovic, A N (2006). Head-to-head comparison of indices of left ventricular contractile reserve assessed by high-dose dobutamine stress echocardiography in idiopathic dilated cardiomyopathy: five-year follow up. Heart 92: 1253-1258 [Abstract] [Full Text]  
• Chantler, P. D., Clements, R. E., Sharp, L., George, K. P., Tan, L.-B., Goldspink, D. F. (2005). The influence of body size on measurements of overall cardiac function. Am. J. Physiol. Heart Circ. Physiol. 289: H2059-H2065 [Abstract] [Full Text]  
• Otasevic, P., Popovic, Z. B., Vasiljevic, J. D., Vidakovic, R., Pratali, L., Vlahovic, A., Nesskovic, A. N. (2005). Relation of myocardial histomorphometric features and left ventricular contractile reserve assessed by high-dose dobutamine stress echocardiography in patients with idiopathic dilated cardiomyopathy. Eur J Heart Fail 7: 49-56 [Abstract] [Full Text]  
• Fincke, R., Hochman, J. S., Lowe, A. M., Menon, V., Slater, J. N., Webb, J. G., LeJemtel, T. H., Cotter, G., SHOCK Investigators, (2004). Cardiac power is the strongest hemodynamic correlate of mortality in cardiogenic shock: A report from the SHOCK trial registry. J Am Coll Cardiol 44: 340-348 [Abstract] [Full Text]  
• Scharf, C., Merz, T., Kiowski, W., Oechslin, E., Schalcher, C., Brunner-La Rocca, H. P. (2002). Noninvasive Assessment of Cardiac Pumping Capacity During Exercise Predicts Prognosis in Patients With Congestive Heart Failure. Chest 122: 1333-1339 [Abstract] [Full Text]  
• Cooke, G.A., Williams, S.G., Marshall, P., Al-Timman, J.K., Shelbourne, J., Wright, D.J., Tan, L.-B. (2002). A mechanistic investigation of ACE inhibitor dose effects on aerobic exercise capacity in heart failure patients. Eur Heart J 23: 1360-1368 [Abstract] [Full Text]  
• Davies, C.H. (2001). Revascularization for cardiogenic shock. QJM 94: 57-67 [Full Text]  
• Williams, S G, Wright, D J, Tan, L B (2000). Management of cardiogenic shock complicating acute myocardial infarction: towards evidence based medical practice. Heart 83: 621-626 [Full Text]  
• Armstrong, G P, Carlier, S G, Fukamachi, K, Thomas, J D, Marwick, T H (1999). Estimation of cardiac reserve by peak power: validation and initial application of a simplified index. Heart 82: 357-364 [Abstract] [Full Text]  
• Wright, D J, Tan, L B (1999). Classic techniques in medicine: The role of exercise testing in the evaluation and management of heart failure. Postgrad. Med. J. 75: 453-458 [Abstract] [Full Text]  
• Cooke, G A, Marshall, P, Al-Timman, J K, Wright, D J, Riley, R, Hainsworth, R, Tan, L B (1998). Physiological cardiac reserve: development of a non-invasive method and first estimates in man. Heart 79: 289-294 [Abstract] [Full Text]