Association between left ventricular ejection fraction, mortality and use of mechanical circulatory support in patients with non-ischaemic cardiogenic shock

Sundermeyer J, Kellner C, Beer BN, Besch L, Dettling A, Bertoldi LF, Blankenberg S, Dauw J, Dindane Z, Eckner D, Eitel I, Graf T, Horn P, Jozwiak-Nozdrzykowska J, Kirchhof P, Kluge S, Linke A, Landmesser U, Luedike P, Lüsebrink E, Majunke N, Mangner N, Maniuc O, Winkler SM, Nordbeck P, Orban M, Pappalardo F, Pauschinger M, Pazdernik M, Proudfoot A, Kelham M, Rassaf T, Scherer C, Schulze PC, Schwinger RH, Skurk C, Sramko M, Tavazzi G, Thiele H, Villanova L, Morici N, Westenfeld R, Winzer EB, Westermann D, Schrage B (2023)

Publication Type: Journal article

Publication year: 2023

Journal

DOI: 10.1007/s00392-023-02332-y

Abstract

Background: Currently, use of mechanical circulatory support (MCS) in non-ischaemic cardiogenic shock (CS) is predominantly guided by shock-specific markers, and not by markers of cardiac function. We hypothesise that left ventricular ejection fraction (LVEF) can identify patients with a higher likelihood to benefit from MCS and thus help to optimise their expected benefit. Methods: Patients with non-ischaemic CS and available data on LVEF from 16 tertiary-care centres in five countries were analysed. Cox regression models were fitted to evaluate the association between LVEF and mortality, as well as the interaction between LVEF, MCS use and mortality. Results: N = 807 patients were analysed: mean age 63 [interquartile range (IQR) 51.5–72.0] years, 601 (74.5%) male, lactate 4.9 (IQR 2.6–8.5) mmol/l, LVEF 20 (IQR 15–30) %. Lower LVEF was more frequent amongst patients with more severe CS, and MCS was more likely used in patients with lower LVEF. There was no association between LVEF and 30-day mortality risk in the overall study cohort. However, there was a significant interaction between MCS use and LVEF, indicating a lower 30-day mortality risk with MCS use in patients with LVEF ≤ 20% (hazard ratio 0.72, 95% confidence interval 0.51–1.02 for LVEF ≤ 20% vs. hazard ratio 1.31, 95% confidence interval 0.85–2.01 for LVEF > 20%, interaction-p = 0.017). Conclusion: This retrospective study may indicate a lower mortality risk with MCS use only in patients with severely reduced LVEF. This may propose the inclusion of LVEF as an adjunctive parameter for MCS decision-making in non-ischaemic CS, aiming to optimise the benefit–risk ratio. Graphical abstract: Impact of left ventricular ejection fraction on mortality and use of mechanical circulatory support in non-ischaemic cardiogenic shock. Hazard ratio for 30-day mortality across the LVEF continuum, adjusted for age, sex, SCAI shock stage, worst value of lactate and pH within 6 h, prior resuscitation and mechanical ventilation during the index shock event. LVEF: Left ventricular ejection fraction; MCS: Mechanical circulatory support; HR: Hazard ratio; CI: Confidence interval. [Figure not available: see fulltext.]

Authors with CRIS profile

Involved external institutions

Paracelsus Medizinische Privatuniversität, Nürnberg Germany (DE) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Humanitas Research Hospital / IRCCS Istituto Clinico Humanitas Italy (IT) Technische Universität Dresden Germany (DE) Kliniken Nordoberpfalz Germany (DE) Charité - Universitätsmedizin Berlin Germany (DE) Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK e.V.) Germany (DE) Institute for Clinical and Experimental Medicine (IKEM) Czech Republic (CZ) Heinrich-Heine-Universität Düsseldorf Germany (DE) Herzzentrum Leipzig Germany (DE) RCCS Fondazione Don Carlo Gnocchi Onlus Italy (IT) Ospedale Niguarda Ca' Granda / ASST Grande Ospedale Metropolitano Niguarda Italy (IT) Universitätsklinikum Essen Germany (DE) Klinikum der Universität München Germany (DE) Universitäts-Herzzentrum Freiburg - Bad Krozingen GmbH Germany (DE) Universitätsklinikum Würzburg Germany (DE) Universitätsklinikum Jena Germany (DE) Azienda Ospedaliera Nazionale SS.Antonio e Biagio e C.Arrigo Italy (IT) St Bartholomew's Hospital United Kingdom (GB)

How to cite

APA:

Sundermeyer, J., Kellner, C., Beer, B.N., Besch, L., Dettling, A., Bertoldi, L.F.,... Schrage, B. (2023). Association between left ventricular ejection fraction, mortality and use of mechanical circulatory support in patients with non-ischaemic cardiogenic shock. Clinical Research in Cardiology. https://doi.org/10.1007/s00392-023-02332-y

MLA:

Sundermeyer, Jonas, et al. "Association between left ventricular ejection fraction, mortality and use of mechanical circulatory support in patients with non-ischaemic cardiogenic shock." Clinical Research in Cardiology (2023).

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