AUTHOR=Whitehead Evan H. , Thayer Katherine L. , Burkhoff Daniel , Uriel Nir , Ohman E. Magnus , O'Neill William , Kapur Navin K. 

TITLE=Central Venous Pressure and Clinical Outcomes During Left-Sided Mechanical Support for Acute Myocardial Infarction and Cardiogenic Shock

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=7

YEAR=2020

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2020.00155

DOI=10.3389/fcvm.2020.00155

ISSN=2297-055X

ABSTRACT=<p><bold>Background:</bold> Right ventricular failure (RVF) is associated with increased mortality among patients receiving left ventricular mechanical circulatory support (LV-MCS) for cardiogenic shock and requires prompt recognition and management. Increased central venous pressure (CVP) is an indicator of potential RVF.</p><p><bold>Objectives:</bold> We studied whether elevated CVP during LV-MCS for acute myocardial infarction complicated by cardiogenic shock is associated with higher mortality.</p><p><bold>Methods:</bold> Between January 2014 and June 2019, we analyzed hemodynamic parameters during Impella LV-MCS from 28 centers in the United States participating in the global, prospective catheter-based ventricular assist device (cVAD) study. A total of 132 patients with a documented CVP measurement while on Impella left-sided support for cardiogenic shock were identified.</p><p><bold>Results:</bold> CVP was significantly higher among patients who died in the hospital (14.0 vs. 11.7 mmHg, <italic>p</italic> = 0.014), and a CVP &gt;12 identified patients at significantly higher risk for in-hospital mortality (65 vs. 45%, <italic>p</italic> = 0.02). CVP remained significantly associated with in-hospital mortality even after adjustment in a multivariable model (adjusted OR 1.10 [95% CI 1.02–1.19] per 1 mmHg increase). LV-MCS suction events were non-significantly more frequent among patients with high vs. low CVP (62.11 vs. 7.14 events, <italic>p</italic> = 0.067).</p><p><bold>Conclusion:</bold> CVP is a single, readily accessible hemodynamic parameter which predicts a higher rate of short-term mortality and may identify subclinical RVF in patients receiving LV-MCS for cardiogenic shock.</p>