Right ventricular-pulmonary coupling and tissue hypoperfusion: a combined echocardiographic and metabolic approach to prognosticate cardiogenic shock

Figures

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  Fig. 1. Selection of research subjects and research flowchart. TAPS: Tricuspid Annular Plane Systolic Excursion; PASP: Pulmonary Artery Systolic Pressure; ROC: Receiver operating characteristic

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  Fig. 2. Boxplot for lactate, MAP,TAPS/PASP at admission, stratified for in hospital mortality. Boxplots of lactate, MAP and TAPS/PASP at admission stratified by in-hospital mortality. The centre line of each box indicates the median; box limits denote the inter-quartile range (25th–75th percentiles); whiskers extend to the minimum and maximum values. Survivors exhibited lower lactate concentrations and higher MAP and TAPS/PASP ratios than non-survivors. TAPS: Tricuspid Annular Plane Systolic Excursion; PASP: Pulmonary Artery Systolic Pressure; MAP: Mean Arterial Pressure

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  Fig. 3. Scatter plot with LOESS smoothing line for TAPS/PASP and lactate. Scatter plots with LOESS curves of smoothing of lactate and correlation between TAPS/PASP showed high non-linear correlation. TAPS:Tricuspid Annular Plane Systolic Excursion; PASP: Pulmonary Artery Systolic Pressure

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  Fig. 4. Multivariate Cox regression analysis. Hazard ratios (HRs) < 1 indicate a protective effect, whereas HRs > 1 indicate increased risk. Squares represent point estimates; horizontal lines show 95 % confidence intervals. For every one standard deviation(SD) (0.053mm/mmHg)increase in TAPS/PASP, the hazard of poor outcome decreased by 31% (HR=0.69, 95% CI: 0.53–0.89), indicating a protective effect. Conversely, every one SD(5.57 mmol/L) increase in lactate was associated with a 50% increase in the hazard of poor outcome (HR=1.50, 95% CI: 1.14–1.97). TAPS: Tricuspid Annular Plane Systolic Excursion; PASP: Pulmonary Artery Systolic Pressure; MAP: Mean Arterial Pressure

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  Fig. 5. Kaplan-Meier survival curves stratified by TAPS/PASP and lactate. Kaplan-Meier survival curves revealed significant differences between high/low TAPS/PASP and high/low lactate. We set 0.3 (the median) as the threshold to differentiate between high and low TAPS/PASP, while the lactate value of 9.93 mmol/L (the median) was established as the cutoff for high and low lactate levels. TAPS: Tricuspid Annular Plane Systolic Excursion; PASP: Pulmonary Artery Systolic Pressure; MAP: Mean Arterial Pressure

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  Fig. 6. ROC Curves in Prediction of In-Hospital-Mortality for lactate,TAPS/PASP and lactate+TAPS/PASP combined model. TAPS: Tricuspid Annular Plane Systolic Excursion; PASP: Pulmonary Artery Systolic Pressure; MAP: Mean Arterial Pressure