Chest
Critical Care: Original ResearchBiventricular Function and Shock Severity Predict Mortality in Cardiac ICU Patients
Graphical Abstract
Section snippets
Study Population
This study was approved by the institutional review board of Mayo Clinic (Identifier, 16-000722) as posing minimal risk to patients and was performed under a waiver of informed consent. We retrospectively analyzed the index CICU admission of consecutive unique adult patients ≥ 18 years of age admitted to the CICU at Mayo Clinic Hospital St. Mary’s Campus between January 1, 2007, and December 31, 2015, who had undergone transthoracic echocardiography (TTE) within 1 day before or after CICU
Study Population
Of 10,004 unique CICU patient admissions, only 5,906 patients had an appropriately timed TTE, and the 4,098 others were excluded (1,616 without TTE and 2,482 with TTE more than 1 day before or after CICU admission). Among this group, only 3,158 had data on RV and left ventricular (LV) function and were included in the final study population; 531 patients were excluded because of missing data for LVEF, and 2,217 were excluded because of missing data on RV function (e-Fig 1). Patients in the
Discussion
In this novel study of a large single-center CICU patient population with comprehensive echocardiographic data, we demonstrate that hospital mortality is associated with the presence and type of ventricular dysfunction in a manner additive to the clinical assessment of shock severity. The prevalence of all forms of ventricular dysfunction increased with increasing CS severity, but a significant minority of patients classified as SCAI shock stage D or E showed no more than mild ventricular
Interpretation
Echocardiographic assessment of ventricular dysfunction provides important clinical and prognostic information to clinicians caring for patients in the CICU. The presence of BVD is associated with higher hospital mortality at any SCAI CS stage, and patients without echocardiographic ventricular dysfunction are a lower-risk cohort. Future CS staging criteria may benefit from the inclusion of ventricular dysfunction assessment in the risk stratification of patients with CS.
Acknowledgments
Author contributions: J. C. J. conceived of the study, designed the data analysis plan, acquired the data, performed statistical analysis, and drafted the manuscript. B. B. conceived of the study, assisted with analysis, and drafted the manuscript. S. v. D., B. M. W., and N. S. A. contributed to the data analysis and drafting of the manuscript. All authors were involved in data interpretation and manuscript revision for intellectual content. All authors provided approval of the final
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FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.