Elevated Central Venous Pressure As A Trigger For Right Heart Failure Evaluation In Patients Receiving Left-sided Mechanical Support For Cardiogenic Shock
Whitehead EH, Thayer K, Burkhoff D, Uriel N, Ohman EM, O'Neill W, and Kapur NK. Elevated Central Venous Pressure As A Trigger For Right Heart Failure Evaluation In Patients Receiving Left-sided Mechanical Support For Cardiogenic Shock. Journal of Cardiac Failure 2020; 26(10):S55.
Journal of Cardiac Failure
Right ventricular failure (RVF) is associated with increased mortality among patients receiving left ventricular mechanical circulatory support (LV-MCS) for cardiogenic shock and requires prompt recognition and management. Increased central venous pressure (CVP) is an indicator of potential RVF. We analyzed the association between hemodynamic parameters and clinical outcomes among 132 patients with cardiogenic shock due to acute myocardial infarction in the cVAD registry who had a CVP measured during left-sided Impella support. CVP was significantly higher among patients who died in the hospital (14.0 vs 11.7 mmHg, p=0.014), and a CVP > 12 identified patients at significantly higher risk for in-hospital mortality (65% vs 45%, p=0.02). CVP remained significantly associated with in-hospital mortality even after adjustment in a multivariable model (adjusted OR 1.10 [95% CI 1.02-1.18] per 1 mmHg increase). LV-MCS suction events were non-significantly more frequent among patients with high versus low CVP (62.11 vs 7.14 events, p=0.067). CVP is a single, readily accessible hemodynamic parameter which predicts a higher rate of short-term mortality and may identify sub-clinical RVF in patients receiving LV-MCS for cardiogenic shock.