Circ-Heart Fail:急性心肌梗死和心力衰竭相关心源性休克的临床特征、住院病程和1年结局比较

2022-05-13 MedSci原创 MedSci原创

HF-CS患者较年轻,尽管心功率输出较低,肺毛细血管楔形压较高,但接受血管加压药或临时机械循环支持的可能性较小。

心源性休克(CS)是一种血流动力学复杂综合征,其病因较多,发病率和死亡率也很高。与急性心肌梗死与(AMI)相关的CS(AMI-CS)相比,人们对与心力衰竭相关的心源性休克(HF-CS)患者的临床特征、住院过程和纵向结局知之甚少。

近日,心血管领域权威杂志Circulation: Heart Failure上发表了一篇研究文章,研究人员在一个单中心登记处评估了520例(219例AMI-CS患者,301例HF-CS患者)连续就诊的CS患者(2017年1月3日,2019年12月31日)的住院和1年结局。

受试者平均年龄为61.5±13.5岁,71%为男性,22%为黑人,63%伴有慢性肾脏疾病。相比于AMI-CS患者,HF-CS患者更年轻(58.5 vs. 65.6岁,P<0.001),更少发生心脏骤停(15.9% vs. 35.2%,P<0.001),更少使用血管加压素(61.8% vs. 82.2%,P<0.001),更高的肺动脉搏动指数(2.14 vs. 1.51,P<0.01),更低的心功率输出(0.64 vs. 0.77W,P<0.001)。P<0.01),更高的肺毛细血管楔形压(25.4 vs. 22.2mmHg,P<0.001)。HF-CS患者接受的短期机械循环支持更少(34.9% vs. 76.3%P<0.001),大出血发生率更低(17.3% vs. 26.0%,P=0.02),住院死亡率也更低(23.9% vs. 39.3%,P<0.001)。

出院后,133例AMI-CS患者和229例HF-CS患者30天再入院率(19.5% vs. 24.5%,P=0.30)和主要不良心脑血管病事件(23.3% vs. 28.8%,P=0.45)相似。HF-CS患者的1年死亡率(n=123,42.6%)低于AMI-CS患者(n=110,52.9%,P=0.03)。HF-CS患者的1年累计死亡率也较低(log-rank检验,P=0.04)。

由此可见,HF-CS患者较年轻,尽管心功率输出较低,肺毛细血管楔形压较高,但接受血管加压药或临时机械循环支持治疗的可能性较小。尽管HF-CS患者的住院死亡率和1年死亡率较低,但两组患者出院后发生重大心血管和脑血管不良事件和30天再次入院的比例相似,这表明两组患者都需要仔细的长期随访。

原始出处:

Shashank S. Sinha, et al.Cardiogenic Shock From Heart Failure Versus Acute Myocardial Infarction: Clinical Characteristics, Hospital Course, and 1-Year Outcomes. Circulation: Heart Failure. 2022;https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.121.009279

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    2022-05-16 1355517cm30暂无昵称

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    2022-05-15 zhaojie88
  5. [GetPortalCommentsPageByObjectIdResponse(id=1843002, encodeId=c76f18430027e, content=<a href='/topic/show?id=112222886b8' target=_blank style='color:#2F92EE;'>#临床特征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22886, encryptionId=112222886b8, topicName=临床特征)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=yeye5224612, createdTime=Thu Jan 05 16:13:23 CST 2023, time=2023-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1219993, encodeId=b45a121999390, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77d93729410, createdName=1355517cm30暂无昵称, createdTime=Mon May 16 13:19:13 CST 2022, time=2022-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332181, encodeId=5455133218162, content=<a href='/topic/show?id=88f9510800b' target=_blank style='color:#2F92EE;'>#心源性休克#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51080, encryptionId=88f9510800b, topicName=心源性休克)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e3fb2500073, createdName=124987cdm26暂无昵称, createdTime=Sun May 15 02:13:23 CST 2022, time=2022-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1357916, encodeId=54e4135e9169d, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sun May 15 02:13:23 CST 2022, time=2022-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563610, encodeId=cd171563610ee, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Sun May 15 02:13:23 CST 2022, time=2022-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1593561, encodeId=83c515935617e, content=<a href='/topic/show?id=9850510e9a3' target=_blank style='color:#2F92EE;'>#心源性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51079, encryptionId=9850510e9a3, topicName=心源性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=955718147815, createdName=mhm295, createdTime=Sun May 15 02:13:23 CST 2022, time=2022-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1219360, encodeId=2cd512193604a, content=很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f8af8162359, createdName=ms4000001629932559, createdTime=Fri May 13 15:05:45 CST 2022, time=2022-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1219324, encodeId=486d121932428, content=不错,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4dfa6526517, createdName=ms5000000644045955, createdTime=Fri May 13 11:46:37 CST 2022, time=2022-05-13, status=1, ipAttribution=)]
    2022-05-15 slcumt
  6. [GetPortalCommentsPageByObjectIdResponse(id=1843002, encodeId=c76f18430027e, content=<a href='/topic/show?id=112222886b8' target=_blank style='color:#2F92EE;'>#临床特征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22886, encryptionId=112222886b8, topicName=临床特征)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=yeye5224612, createdTime=Thu Jan 05 16:13:23 CST 2023, time=2023-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1219993, encodeId=b45a121999390, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77d93729410, createdName=1355517cm30暂无昵称, createdTime=Mon May 16 13:19:13 CST 2022, time=2022-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332181, encodeId=5455133218162, content=<a href='/topic/show?id=88f9510800b' target=_blank style='color:#2F92EE;'>#心源性休克#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51080, encryptionId=88f9510800b, topicName=心源性休克)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e3fb2500073, createdName=124987cdm26暂无昵称, createdTime=Sun May 15 02:13:23 CST 2022, time=2022-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1357916, encodeId=54e4135e9169d, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sun May 15 02:13:23 CST 2022, time=2022-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563610, encodeId=cd171563610ee, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Sun May 15 02:13:23 CST 2022, time=2022-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1593561, encodeId=83c515935617e, content=<a href='/topic/show?id=9850510e9a3' target=_blank style='color:#2F92EE;'>#心源性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51079, encryptionId=9850510e9a3, topicName=心源性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=955718147815, createdName=mhm295, createdTime=Sun May 15 02:13:23 CST 2022, time=2022-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1219360, encodeId=2cd512193604a, content=很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f8af8162359, createdName=ms4000001629932559, createdTime=Fri May 13 15:05:45 CST 2022, time=2022-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1219324, encodeId=486d121932428, content=不错,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4dfa6526517, createdName=ms5000000644045955, createdTime=Fri May 13 11:46:37 CST 2022, time=2022-05-13, status=1, ipAttribution=)]
    2022-05-15 mhm295
  7. [GetPortalCommentsPageByObjectIdResponse(id=1843002, encodeId=c76f18430027e, content=<a href='/topic/show?id=112222886b8' target=_blank style='color:#2F92EE;'>#临床特征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22886, encryptionId=112222886b8, topicName=临床特征)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=yeye5224612, createdTime=Thu Jan 05 16:13:23 CST 2023, time=2023-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1219993, encodeId=b45a121999390, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77d93729410, createdName=1355517cm30暂无昵称, createdTime=Mon May 16 13:19:13 CST 2022, time=2022-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332181, encodeId=5455133218162, content=<a href='/topic/show?id=88f9510800b' target=_blank style='color:#2F92EE;'>#心源性休克#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51080, encryptionId=88f9510800b, topicName=心源性休克)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e3fb2500073, createdName=124987cdm26暂无昵称, createdTime=Sun May 15 02:13:23 CST 2022, time=2022-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1357916, encodeId=54e4135e9169d, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sun May 15 02:13:23 CST 2022, time=2022-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563610, encodeId=cd171563610ee, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Sun May 15 02:13:23 CST 2022, time=2022-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1593561, encodeId=83c515935617e, content=<a href='/topic/show?id=9850510e9a3' target=_blank style='color:#2F92EE;'>#心源性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51079, encryptionId=9850510e9a3, topicName=心源性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=955718147815, createdName=mhm295, createdTime=Sun May 15 02:13:23 CST 2022, time=2022-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1219360, encodeId=2cd512193604a, content=很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f8af8162359, createdName=ms4000001629932559, createdTime=Fri May 13 15:05:45 CST 2022, time=2022-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1219324, encodeId=486d121932428, content=不错,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4dfa6526517, createdName=ms5000000644045955, createdTime=Fri May 13 11:46:37 CST 2022, time=2022-05-13, status=1, ipAttribution=)]
    2022-05-13 ms4000001629932559

    很好

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1843002, encodeId=c76f18430027e, content=<a href='/topic/show?id=112222886b8' target=_blank style='color:#2F92EE;'>#临床特征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22886, encryptionId=112222886b8, topicName=临床特征)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=yeye5224612, createdTime=Thu Jan 05 16:13:23 CST 2023, time=2023-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1219993, encodeId=b45a121999390, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77d93729410, createdName=1355517cm30暂无昵称, createdTime=Mon May 16 13:19:13 CST 2022, time=2022-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332181, encodeId=5455133218162, content=<a href='/topic/show?id=88f9510800b' target=_blank style='color:#2F92EE;'>#心源性休克#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51080, encryptionId=88f9510800b, topicName=心源性休克)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e3fb2500073, createdName=124987cdm26暂无昵称, createdTime=Sun May 15 02:13:23 CST 2022, time=2022-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1357916, encodeId=54e4135e9169d, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sun May 15 02:13:23 CST 2022, time=2022-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563610, encodeId=cd171563610ee, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Sun May 15 02:13:23 CST 2022, time=2022-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1593561, encodeId=83c515935617e, content=<a href='/topic/show?id=9850510e9a3' target=_blank style='color:#2F92EE;'>#心源性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51079, encryptionId=9850510e9a3, topicName=心源性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=955718147815, createdName=mhm295, createdTime=Sun May 15 02:13:23 CST 2022, time=2022-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1219360, encodeId=2cd512193604a, content=很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f8af8162359, createdName=ms4000001629932559, createdTime=Fri May 13 15:05:45 CST 2022, time=2022-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1219324, encodeId=486d121932428, content=不错,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4dfa6526517, createdName=ms5000000644045955, createdTime=Fri May 13 11:46:37 CST 2022, time=2022-05-13, status=1, ipAttribution=)]
    2022-05-13 ms5000000644045955

    不错,学习了。

    0

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