Hemodynamic profile of obesity in cardiogenic shock

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Abstract Background There is a growing understanding that cardiogenic shock (CS) is a hemodynamically heterogenous condition. Hemodynamic variants within this entity are not well studied but, if recognize, may help to optimize therapies. Purpose We explored hemodynamics in patients with CS based on their body mass index (BMI). Methods The Cardiogenic Shock Working Group (CSWG) registry includes patients with CS, regardless of etiology, from 17 clinical sites across the USA. We stratified the participants into BMI quartiles (BMI≤24.4 kg/m2, 24.433.1 kg/m2), and studied the hemodynamic variables in CS depending on body mass index (BMI). Results The total cohort consisted of 3,492 patients admitted with CS (mean age 62.1±14 years, 69% male), including 2,024 (58.0%) of CS related to advanced heart failure (HF-CS) and 969 (27.8%) acute myocardial infarction (AMI) related CS. IN HF-CS, more obese patients in higher BMI quartile had larger left ventricle, higher ejection fraction, and greater cardiac output (Table). Their systolic blood pressure was higher, and pulmonary artery pressure was lower than in lower BMI quartiles. Their pulmonary artery pulsatility index decreased from 2.2±1.4 in the second quartile to 1.6±1.3 in the forth (highest) quartile. Mortality in creased with the BMI increase, from 23.3% in the lowest BMI quartile to 30% in the highest BMI quartile, p=0.0128. In AMI-CS, there was no distinct hemodynamic profile related to obesity. Conclusions In cardiogenic shock related to heart failure, unlike in AMI-related cardiogenic shock, there is a distinct hemodynamic pattern of obesity, consistent with larger left ventricle, higher ejection fraction, higher cardiac output and systemic pressure, higher right atrial pressure, and lower pulmonary artery pulsatility index. In this subset, obesity is associated with the highest in-hospital mortality.