Abstract 13676: Characteristics and Outcomes of Patients With Clinically Significant Valvular Heart Disease and Cardiogenic Shock Admitted to Cardiac Intensive Care Units
Anthony P Carnicelli, Elliott Miller, Meshe Chonde, David Berg, Michael Palazzolo, Nijat Aliyev, Erin A Bohula, Madeleine Hamilton, Ryan Keane, Jonathan Kusner, Daniel Loriaux, L Kristin K Newby, Harsh Patolia, Jacob Pierce, Sean Van Diepen, Jason N Katz, David Morrow- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Introduction: Little is known about the characteristics & outcomes of patients (pts) with significant valvular heart disease (VHD) and cardiogenic shock (CS). In addition, differences between pts with CS due to VHD vs VHD as “bystander” to CS have not been described.
Methods: The Critical Care Cardiology Trials Network is a multicenter network of CICUs in North America coordinated by the TIMI Study Group. Participating centers capture all CICU admissions for 2 months annually. Pts with CS and significant VHD were classified as having CS due to VHD or CS with concomitant VHD not felt to be the cause of CS. Admissions from 2017 - 2021 were analyzed.
Results: Of 3,974 CICU admissions with CS, 165 (4.2%) had CS due to VHD and 769 (19.4%) had CS with concomitant VHD. Pts with CS due to VHD were older (71 vs 67 y), less commonly had a hx of HF (47.3% vs 73.1%), & more commonly had LVEF>50% on admission (51.5% vs 16.8%); p<0.001 for all. Resource use varied significantly (Fig). Nearly 1/3 of pts (30.3%) with CS due to VHD underwent surgical/transcatheter valve procedures during CICU admission, contrasting with those with CS and concomitant VHD (13.5%; p<0.001). In-hospital mortality was similar between the 2 VHD groups (39.4% vs 33.8%, p=0.17). In-hospital mortality for allcomers with CS and VHD (concomitant or causative) was higher than in those with CS and no VHD (34.8% vs 29.7%; p=0.003), including adjusted for age, sex, SOFA score, and pre-CICU cardiac arrest (aOR 1.23; 1.03-1.47). Mortality was numerically lower in pts undergoing a valve procedure (23.4% died; 16% with CS due to VHD, 26.9% with CS and concomitant VHD; p=0.13), compared to pts who did not (37.1% overall; 49.6% & 34.9%, respectively; p=0.003).
Conclusions: Although VHD is the primary cause of CS in a minority of pts, the presence of significant VHD is associated with higher mortality. In contemporary CICUs, procedural intervention is undertaken in ~1/3 of cases and mortality was numerically lower in pts who underwent valve procedures.