Diagnosis of cardiogenic shock without the use of a pulmonary artery catheter

Howard A. Cooper*, Amir H. Najafi, Kambiz Ghafourian, Andre R m Paixao, Mohamed Aljaabari, Micaela Iantorno, Daniel Caños, Federico M. Asch, Julio A. Panza

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

BACKGROUND: Current diagnostic criteria for cardiogenic shock (CS) require the use of a pulmonary artery catheter (PAC), which is time-consuming and may cause complications. A set of simple yet accurate noninvasive diagnostic criteria would be of significant utility.

METHODS: Candidate components for the Noninvasive Parameters for Assessment of Cardiogenic Shock (N-PACS) criteria were required to be objective, readily available, and noninvasive. Variables encompassing hypotension, hypoperfusion, predisposing conditions, and elevated intracardiac filling pressures were optimized versus a PAC-based standard in a retrospective developmental cohort of 122 patients with acute myocardial infarction (AMI). The finalized criteria were validated in a prospective cohort of coronary care unit patients in whom a PAC was placed for clinical indications.

RESULTS: According to invasive criteria, CS was present in 32 of 217 consecutive patients undergoing PAC. Compared to the PAC-based standard, the N-PACS criteria had a sensitivity of 96.9% (95% confidence interval (CI) 82.0-99.8), specificity of 90.8% (95% CI 85.5-94.4), positive predictive value of 64.6% (95% CI 49.4-77.4), negative predictive value of 99.4% (95% CI 96.2-100), positive likelihood ratio of 10.5 (95% CI 6.7-16.7), negative likelihood ratio of 0.03 (95% CI 0.00-0.24), and diagnostic odds ratio of 306.4. Results were similar among patients with and without AMI.

CONCLUSION: A simple, echocardiography-based set of noninvasive diagnostic criteria can be used to accurately diagnose CS.

Original languageEnglish (US)
Pages (from-to)88-95
Number of pages8
JournalEuropean heart journal. Acute cardiovascular care
Volume4
Issue number1
DOIs
StatePublished - Feb 1 2015

Keywords

  • Shock
  • diagnosis
  • echocardiography

ASJC Scopus subject areas

  • Medicine(all)

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