Prognostischer Aussagewert des linksventrikulären enddiastolischen Drucks (LVEDP) auf die Mortalität bei Patienten mit Infarkt-bedingtem kardiogenem Schock
Various indicators have been shown in many previous studies as predictors. However, there is to date no study conducted investigating LVEDP (left ventricular end-diastolic pressure) as a potential predictor of death in patients with AMI-CS. In our current study, we aimed to investigate LVEDP as a potential factor predicting the mortality in patients diagnosed with AMI-CS. A total of 40 patients with AMI-CS was included in our study. The patients were retrospectively recruited from the Essen university hospital during the period from 2016 to 2021.
The mean LVEDP value was 22.2 mmHg. Our results have shown a significant increase of LVEDP Value among the non-survivors (28.9 mmHg) compared to survivors (16.2 mmHg). In the binary regression analysis, a significant association between LVEDP and the 30-day mortality (P = 0.004) was observed. In the multiple regression analysis, this increase was found to be marginal (P = 0.05). We utilized the provided ROC curve to establish a cut-off value. In the curve analysis, a cut-off value of 24.63 was identified. These results yielded a moderate sensitivity of 61.11 % and a high specificity of 95 %. The positive predictive value (PPV) was 91.7, while the negative predictive value (NPV) was 73.1 %.
The Society for Cardiovascular Angiography and Intervention (SCAI) classification has been shown to be significant in the secondary endpoints for both binary regression analysis (P-value 0.004) as well as in the multiple regression analysis (P-value 0.031). In the binary regression analysis, the incidence of sepsis was significant. However, this variable was no longer significant in the in the multiple regression analysis. Initial lactate levels were not significant in either binary regression analysis or multiple regression analysis.
In summary, the measurement of the LVEDP in patients undergoing Impella for infarction-related cardiogenic shock may provide a prognostic value and helpful for the therapy selection. However, further extensive investigations are required to validate our findings.