The prognostic value of pulmonary artery compliance in cardiogenic shock.

Abstract

The aim of this study was to evaluate the pathophysiological role and the prognostic significance of pulmonary artery compliance (CPA), a measure of right ventricular pulsatile afterload, in cardiogenic shock. We retrospectively included 91 consecutive patients with cardiogenic shock due to primary left ventricular failure, monitored with a pulmonary artery catheter within the first 24 h. CPA was calculated as the ratio of stroke volume to pulmonary artery pulse pressure, and we determined whether CPA predicted mortality and whether it performed better than other pulmonary hemodynamic variables. The overall in-hospital mortality in our cohort was 27%. Survivors and nonsurvivors had comparable left ventricular ejection fraction, systolic, diastolic and mean pulmonary artery pressure, transpulmonary gradient, diastolic pressure gradient, and pulmonary vascular resistance at 24 h. In contrast, CPA was the only pulmonary artery variable significantly associated with mortality in univariate and multivariate analyses. Mortality increased from 4.5% at the highest quartile of CPA (3.6–6.5 mL/mmHg) to 43.5% at the lowest quartile (0.7–1.7 mL/mmHg). In 64 patients with a PAC inserted immediately upon admission, we calculated the trend of CPA between admission and 24 h. This trend was positive in survivors (+0.8 ± 1.3 ml/mmHg) but negative in nonsurvivors (−0.1 ± 1.0 mL/mmHg). The lower CPA in nonsurvivors was associated with more severe right ventricular systolic dysfunction. In conclusion, a reduced compliance of the pulmonary artery promotes right ventricular dysfunction and is independently associated with mortality in cardiogenic shock. Future studies should evaluate the impact on pulmonary arterial compliance and right ventricular afterload of therapies used in cardiogenic shock.