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

doi:10.1177/2048872614534564

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

Medicine, Cardiology Division

Research output: Contribution to journal › Article › peer-review

6 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 language	English (US)
Pages (from-to)	88-95
Number of pages	8
Journal	European heart journal. Acute cardiovascular care
Volume	4
Issue number	1
DOIs	https://doi.org/10.1177/2048872614534564
State	Published - Feb 1 2015

Keywords

Shock
diagnosis
echocardiography

ASJC Scopus subject areas

General Medicine

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@article{be9d1be423dc43ca94760b7a9ee0bf66,

title = "Diagnosis of cardiogenic shock without the use of a pulmonary artery catheter",

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.",

keywords = "Shock, diagnosis, echocardiography",

author = "Cooper, {Howard A.} and Najafi, {Amir H.} and Kambiz Ghafourian and Paixao, {Andre R m} and Mohamed Aljaabari and Micaela Iantorno and Daniel Ca{\~n}os and Asch, {Federico M.} and Panza, {Julio A.}",

note = "Publisher Copyright: {\textcopyright} The European Society of Cardiology 2014.",

year = "2015",

month = feb,

day = "1",

doi = "10.1177/2048872614534564",

language = "English (US)",

volume = "4",

pages = "88--95",

journal = "European heart journal. Acute cardiovascular care",

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TY - JOUR

T1 - Diagnosis of cardiogenic shock without the use of a pulmonary artery catheter

AU - Cooper, Howard A.

AU - Najafi, Amir H.

AU - Ghafourian, Kambiz

AU - Paixao, Andre R m

AU - Aljaabari, Mohamed

AU - Iantorno, Micaela

AU - Caños, Daniel

AU - Asch, Federico M.

AU - Panza, Julio A.

PY - 2015/2/1

Y1 - 2015/2/1

N2 - 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.

AB - 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.

KW - Shock

KW - diagnosis

KW - echocardiography

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U2 - 10.1177/2048872614534564

DO - 10.1177/2048872614534564

M3 - Article

C2 - 24833639

AN - SCOPUS:84952716104

SN - 2048-8726

VL - 4

SP - 88

EP - 95

JO - European heart journal. Acute cardiovascular care

JF - European heart journal. Acute cardiovascular care

IS - 1

ER -

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

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