Previous Left Ventricular Dysfunction Research Articles

0221 : Cardiogenic shock mechanism complicating STEMI and its impact on the prognosis: about 126 cases

Cardiogenic shock is the expression of an acute and severe dysfunction of cardiac pump causing a deep alteration of peripheral perfusion and progressive tissue anoxia. Studying the mechanisms of cardiogenic shock complicating STEMI, hospitalized in our department and their impact on prognosis. A retrospective and descriptive study, conducted from medical observations of patients hospitalized with myocardial infarction, complicated by cardiogenic shock between April 2010 and June 2015. 126 patients were collected, the average age of our patients was 62.67±12.09 years. A male predominance was observed with a sex ratio of 5/1. 38.1% of the population were diabetics, 9.5% had a history of myocardial infarction. 5 patients had previous left ventricular dysfunction on echocardiography. The admission average delay was 9 hours and 24 minutes. The average time for installation of shock over the myocardial infarction was 12.5±13.53 hours. Over half of the patients were already under vasoactive drugs to their admission. A quarter of patients was stable at admission and secondarily had presented a delayed shock. The mean ejection fraction 37.26±17.10%. The extent myocardial ischemia was the most frequent shock mechanism (69%). Mechanical complications accounted for 21.4% of cases. The angioplasty was realized in 77% of cases, thrombolysis in 11.1% of cases and a surgical treatment in 11.9% of cases. Overall mortality was 72.6%. The mortality rate of patients with mechanical complication was 88.9% versus 69.9% in the extensive myocardial ischemia group and 80% in the group extension to the right ventricle. No significant difference was observed between the different mechanisms (p=0.250). Cardiogenic shock complicating STEMI is a poor prognosis with a high mortality rate, independently of the pathophysiological mechanism. The author hereby declares no conflict of interest

Usefulness of Bedside Testing for Brain Natriuretic Peptide to Identify Right Ventricular Dysfunction and Outcome in Normotensive Patients With Acute Pulmonary Embolism

Echocardiographic right ventricular (RV) dysfunction is a well-established prognostic indicator in patients with acute pulmonary embolism. However, the possibility of implementing a rapid and effective triage with biohumoral markers such as brain natriuretic peptide (BNP) may be of value. Sixty-one patients with a first documented episode of acute pulmonary embolism without shock and previous left ventricular dysfunction were prospectively studied. All patients underwent echocardiography and rapid BNP testing on admission. Patients were followed up for in-hospital death, progression to shock, and nonfatal pulmonary embolism recurrence. Overall, 35 patients (57%) had echocardiographic evidence of RV dysfunction on admission, and its prevalence increased progressively with increasing levels of BNP. A BNP level <85 pg/ml was highly accurate in excluding RV dysfunction. No patient in the lower tertile of BNP values (1.1 to 85.0 pg/ml) had RV dysfunction, compared with 75% in the middle tertile (88.7 to 487.0 pg/ml) and 100% in the upper tertile (527 to 1,300 pg/ml). Overall, 11 patients (18%), belonging to the upper tertile, progressed to shock during admission, 4 of whom died. The association of RV dysfunction with a BNP level in the upper tertile (>or=527 pg/ml) showed incremental prognostic value over RV dysfunction alone (in-hospital death and progression to shock were 55% and 31%, respectively). In the present study, BNP represented a powerful predictor of in-hospital clinical deterioration, with substantial incremental prognostic value over echocardiography alone.