TOP8: Pharmacological and Mechanical Circulatory Support in Cardiogenic Shock: Does Obesity Put the Patients at Disadvantage?

Abstract

Background: In cardiogenic shock (CS), the hemodynamic profile of obesity and requirement for hemodynamic support based on body mass index (BMI) is not well studied. We aimed to explore the hemodynamic characteristics and vasopressor/inotrope/mechanical circulatory support (MCS) requirements across the BMI spectrum. Methods: The Cardiogenic Shock Working Group (CSWG) registry includes patients with CS from 17 clinical sites across the USA. We stratified the participants into BMI quartiles, from 1 to 4, as follows: BMI≤24.4 kg/m2, 24.4<BMI≤28.3 kg/m2, 28.3<BMI≤33.1 kg/m2, and BMI>33.1 kg/m2. We then compared hemodynamic variables and utilization of vasopressors/inotropes and MCS across the strata. Results: A total of the 3,492 patients with known BMI were included. While the heart rate was similar across the quartiles, both systemic blood pressure and filling cardiac pressures increased from lower to higher BMI quartiles. Cardiac output also increased, cardiac index did not change, and pulmonary artery pulsatility index (PAPI) decreased as the BMI was increasing (Table). The requirements in pharmacological hemodynamic support was also higher in obese individual. The proportion of patients, requiring two and more vasopressor/inotropic agents, increased from 12.1% in the lowest quartile to 19.1% in the highest quartile, p<0.0001. At the same time, device utilization, including intraaortic balloon pump, Impella, and venoarterial extracorporeal membrane oxygenation (VA ECMO), and the combination of the above, remained similar across the subsets. Conclusions: In cardiogenic shock, the hemodynamic profile differs based on BMI. Obese patients have highest systolic and mean blood pressure, cardiac output, pulmonary arterial pressure, and filling pressures. At the same time, they demonstrate the lowest pulmonary artery pulsatility index. More obese individuals have higher requirements in pharmacological support (Vasopressors/inotropes). The use of MCS is similar across the BMI quartiles.