Characteristics and Outcomes of Patients With Cardiogenic Shock and Clinically Significant Valvular Heart Disease: From the Critical Care Cardiology Trials Network.
Feb 17, 2025DOI: 10.1016/j.cardfail.2025.01.019Journal ArticleJCF
Written by: Anthony P CarnicelliP Elliott MillerDavid D BergNijat AliyevCarlos L AlviarErin A BohulaSunit-Preet ChaudhryMeshe ChondeChristine ChowHoward A CooperLori B DanielsChristopher B FordyceShahab GhafghaziMichael J GoldfarbKari L GorderMadeleine M HamiltonRyan R KeaneMichael C KontosJonathan J KusnerEvan LeibnerDaniel B LoriauxVenu MenonRaunak M NairL Kristin NewbyMary-Tiffany OduahMichael G PalazzoloHarsh PatoliaJacob B PierceMatthew J PierceBrian J PotterAlastair ProudfootRobert O RoswelGregory SchnellJeffrey ShawKiran SidhuShashank S SinhaAnubodh S VarshneyJason N KatzSean VAN DiepenDavid A Morrow
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SC
Dr. Sunit-Preet Chaudhry
Advanced Heart Failure · Ascension St. Vincent Hospital
EL
Dr. Evan Leibner
Critical Care · Mount Sinai
SV
Dr. Sunny Varshney
Advanced Heart Failure · Stanford
Summary
BACKGROUND: Cardiogenic shock (CS) can be complicated by severe valvular heart disease (VHD). We analyzed cardiac intensive care unit (CICU) admissions according to VHD status.METHODS AND RESULTS: The Critical Care Cardiology Trials Network is a multicenter network of tertiary CICUs. Centers contributed data from consecutive admissions during 2-month annual snapshots from 2017-2023. CS admissions were classified as having CS attributed to VHD, CS with noncausative VHD or CS without severe VHD. Demographics and therapies were compared. Unadjusted and adjusted odds ratios for in-hospital mortality were calculated. We analyzed 5242 admissions with CS (4.1% attributed to VHD, 18.8% with noncausative VHD, 77.1% without severe VHD). Mitral regurgitation (32.1%) and aortic stenosis (27.9%) were the most common pathologies in CS attributed to VHD. Admissions with CS attributed to VHD more commonly had LVEF ≥ 40% on admission (present in 62.8%, 22.6% and 15.1%, respectively; P < 0.001). Valve intervention was performed in 32.1% of those with CS attributed to VHD. Unadjusted in-hospital mortality in admissions with CS attributed to VHD was 40.0%, compared to 33.4% and 30.3% in the other groups.CONCLUSIONS: VHD is the underlying cause of CS in a minority of CICU admissions but is associated with high in-hospital mortality rates.
SV
Dr. Sunny Varshney
Cardiology · Advanced Heart Failure & TransplantationStanford MedicinesunnyStanford, CA
