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098 Mid-term follow up of consecutive patients with cardiogenic shock without acute coronary syndrome

Authors
Publisher
Elsevier France
Publication Date
Volume
2
Issue
1
Identifiers
DOI: 10.1016/s1878-6480(10)70100-2
Disciplines
  • Biology
  • Medicine

Abstract

Pronostic of cardiogenic shock (CS) is severe and mortality is still more than 50%. Aim of the study Prospective study of patients consecutively hospitalized for a first CS due to cardiomyopathy (CM) with LV dysfunction and a 18-month period of follow-up. Inclusion criteria CS is defined by systolic BP<80mmHg or hemodynamic support with peripheral hypoperfusion. All patients had echocardiography, coronarography and biological evaluation (troponine and NTproBNP). Regular follow-up was realized at 1, 3 and 6 months using echocardiography, stress test with oxygen consumption and therapeutic adaptation (βblockers). Exclusion criteria acute coronary syndrome, septic, anaphylactic, hypovolemic shock. Results 24 patients (90% men) mean age 57,5±11,2 y were included; 8 ischemic CM, 15 dilated CM [11 idiopathic, 3 toxic (alcohol n=4 ; iatrogene n=1), 1 myocarditis] et 1 restrictive CM (haemochromatose). Cardiovascular risks were diabetes with HbA1c > 8% (n=11), HBP (n=7), tabacco (n=9), dyslipidemia (n=8). Upon admission NT proBNP value was 5025ng/mL and 1730ng/ml 8 weeks later. The mean LVEF was initially 23±8% and 39,5±13,7% at the end of the follow up. The duration of hospitalisation was 12±15 days. initial 6 mois 18 mois NYHA IV Stage (%) 100 20 18 LBBB(%) 46 Creatininemia (umol/l) 150 ± 100 130 ± 50 127 ± 42 LVEF% 24 ± 9% 30 ± 8% 39,5± 13,7 LVEDD (mm) 64±9 62 ± 10 61± 20,3 SPAP (mmHg) 50±14 49 ± 10 30 ± 9,4 NT pro BNP (ng/ml) 5025±8200 3800±6200 1730 ± 4200 At the end of the follow up, in 6 patients heart failure symptoms decreased and 3 patients normalized their LVEF. 3 patients alone had a βblocker treatment, 2 resynchronisations, and with DAI for 1 patient and 2 transplantations. 3 patients died due to cardiogenic complications (all with an ischemic cardiomyopathy) and 7 patients had iterative hospitalisation for heart failure. Conclusion The pronostic of cardiogenic shock without acute coronary syndrome is better with the improvement of therapeutic methods but, in this study the severity was important: death = 12.5%, morbidity = 31.2%.

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