Key result
Higher LVSWI is linked to ~34% lower in-hospital mortality per 10 J/m2 across SCAI shock stages.
Why the study?
To determine whether echocardiographic left ventricular stroke work index could refine mortality risk stratification by the SCAI shock classification in the CICU.
Does echocardiographic left ventricular stroke work index (LVSWI) refine mortality risk stratification by SCAI shock classification in CICU patients?
Cohort (n=3,635)
Does echocardiographic left ventricular stroke work index (LVSWI) refine mortality risk stratification by SCAI shock classification in CICU patients?
Effect estimate: OR 0.66
Echocardiographic LVSWI noninvasively characterizes shock severity and refines in-hospital mortality risk stratification across SCAI shock stages in CICU patients.
May support LVSWI integration into SCAI staging for CICU risk stratification; hypothesis-generating and requires prospective validation.
BACKGROUND: Echocardiographic findings vary with shock severity, as defined by the Society for Cardiovascular Angiography and Intervention (SCAI) shock stage. Left ventricular stroke work index (LVSWI) measured by transthoracic echocardiography (TTE) can predict mortality in the cardiac intensive care unit (CICU). We sought to determine whether LVSWI could refine mortality risk stratification by the SCAI shock classification in the CICU. METHODS: We included consecutive CICU patients from 2007 to 2015 with TTE data available to calculate the LVSWI, specifically the mean arterial pressure, stroke volume index and medial mitral E/e' ratio. In-hospital mortality as a function of LVSWI was evaluated across the SCAI shock stages using logistic regression, before and after multivariable adjustment. RESULTS: We included 3635 unique CICU patients, with a mean age of 68.1 ± 14.5 years (36.5% females); 61.1% of patients had an acute coronary syndrome. The LVSWI progressively decreased with increasing shock severity, as defined by increasing SCAI shock stage. A total of 203 (5.6%) patients died during hospitalization, with higher in-hospital mortality among patients with lower LVSWI (adjusted OR 0.66 per 10 J/m2 higher) or higher SCAI shock stage (adjusted OR 1.24 per each higher stage). A LVSWI <33 J/m2 was associated with higher adjusted in-hospital mortality, particularly among patients with shock (SCAI stages C, D and E). CONCLUSIONS: The LVSWI by TTE noninvasively characterizes the severity of shock, including both systolic and diastolic parameters, and can identify low-risk and high-risk patients at each level of clinical shock severity.
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Jentzer et al. (2022) conducted a cohort in Cardiac intensive care unit (CICU) patients (n=3,635). Left ventricular stroke work index (LVSWI) was evaluated on In-hospital mortality (OR 0.66). Higher left ventricular stroke work index (LVSWI) was associated with lower in-hospital mortality (adjusted OR 0.66 per 10 J/m2 higher) and refined risk stratification across SCAI shock stages.
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