The following is a summary of “Noninvasive Hemodynamic Characterization of Shock and Preshock Using Echocardiography in Cardiac Intensive Care Unit Patients,” published in the November 2023 issue of Cardiology by Jentzer et al.

Understanding the hemodynamics of shock and preshock in cardiac intensive care unit (ICU) patients is crucial in managing critical conditions. This study focused on noninvasively assessing these conditions through transthoracic echocardiography (TTE). Data from Mayo Clinic cardiac ICU patients between 2007 and 2015 who underwent TTE within a day of admission were analyzed. Patients were classified into four groups based on the presence of hypotension, hypoperfusion, or both at ICU admission. Among the 5,375 included patients (median age: 69.2 years; 36.8% women), distinct echocardiographic patterns were evident across groups, reflecting varying degrees of hemodynamic compromise. Worsening biventricular function reduced forward flow, and increased filling pressures were observed as the severity of hemodynamic compromise increased. In-hospital mortality, occurring in 8.2% of cases, was associated with more pronounced abnormalities in TTE parameters. Importantly, mortality risk intensified with greater hemodynamic compromise, with a clear gradient in mortality rates observed when TTE findings and clinical classifications of shock and preshock were combined, underscoring the importance of comprehensive hemodynamic assessments in prognostication.

This study delves into the profound differences in cardiac function among cardiac ICU patients experiencing preshock and shock elucidated through TTE. Furthermore, it highlights the considerable potential of combining clinical classification with TTE-derived hemodynamic insights to stratify mortality risks effectively in critically ill patients.

Source: ahajournals.org/doi/10.1161/JAHA.123.031427