title: Prognosis value of central venous oxygen saturation in acute decompensated heart failure.
abstract: BACKGROUND
  Central venous oxygen saturation (ScvO2) provides an estimation of body oxygen consumption/delivery ratio. Its use has been suggested for monitoring treatment of patients admitted for acute decompensated heart failure (ADHF) but the optimal target value has never been clearly reported.
  
  
  OBJECTIVE
  We aimed to address the prognostic value of ScvO2 in ADHF requiring inotrope support.
  
  
  METHODS
  ScvO2 was prospectively assessed in 60 patients with ADHF requiring inotrope support (mean age 62±16 years; 45 men; left ventricular ejection fraction 25±7%) and was compared with major adverse cardiac events (MACE), defined as heart transplantation, cardiac assistance and death.
  
  
  RESULTS
  MACE occurred in 22 (35%) patients (14 deaths; eight referred for heart transplantation or cardiac assistance). Admission ScvO2 (mean 57±13%) did not differ between patients with and without MACE. At 24 hours ScvO2 (mean 62±7%) increased only in patients without MACE (65±6% vs. 58±7%; p<0.0001) and was associated with urine output, vena cava diameter and oxygen consumption reduction. No correlation was observed between ScvO2 and cardiac output or catecholamine rate. Multivariable analysis showed that ScvO2 at 24 hours remained an independent predictor of MACE. Using the optimal cut-off of 60% derived from receiver operating characteristic curves, MACE were observed in 81% of patients (17/21) with ScvO2≤60% at 24 hours vs. 13% (5/39) with ScvO2>60% at 24 hours.
  
  
  CONCLUSIONS
  In patients admitted for ADHF requiring inotrope support, ScvO2≤60% despite optimal treatment is a marker of poor outcome and might be an indicator for considering more aggressive therapy.
authors.affiliation: Inserm U955, department of cardiovascular medicine, Henri-Mondor hospital, AP-HP, university hospital Henri-Mondor, 51, avenue de Lattre-de-Tassigny, 94010 Créteil, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Gallet
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lellouche
authors.forename: Laurens
authors.initials: L
authors.lastname: Mitchell-Heggs
authors.forename: Belaid
authors.initials: B
authors.lastname: Bouhemad
authors.forename: Alexandre
authors.initials: A
authors.lastname: Bensaid
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Dubois-Randé
authors.forename: Pascal
authors.initials: P
authors.lastname: Gueret
authors.forename: Pascal
authors.initials: P
authors.lastname: Lim
mesh_terms: D000208:Acute Disease; D002316:Cardiotonic Agents / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D010101:Oxygen Consumption / Q000502:physiology*; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume; D016277:Ventricular Function, Left
chemical_list: D002316:Cardiotonic Agents; D010100:Oxygen