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

Authors :
Cooper HA
Najafi AH
Ghafourian K
Paixao AR
Aljaabari M
Iantorno M
Caños D
Asch FM
Panza JA
Source :
European heart journal. Acute cardiovascular care [Eur Heart J Acute Cardiovasc Care] 2015 Feb; Vol. 4 (1), pp. 88-95. Date of Electronic Publication: 2014 May 15.
Publication Year :
2015

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.<br />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.<br />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.<br />Conclusion: A simple, echocardiography-based set of noninvasive diagnostic criteria can be used to accurately diagnose CS.<br /> (© The European Society of Cardiology 2014.)

Details

Language :
English
ISSN :
2048-8734
Volume :
4
Issue :
1
Database :
MEDLINE
Journal :
European heart journal. Acute cardiovascular care
Publication Type :
Academic Journal
Accession number :
24833639
Full Text :
https://doi.org/10.1177/2048872614534564