Diagnosis of cardiogenic shock without the use of a pulmonary artery catheter.
BACKGROUND
Current diagnostic criteria for cardiogenic shock (CS) require the use of a pulmonary artery catheter (PAC), which is time-consuming and may cause complications. A set of simple yet accurate noninvasive diagnostic criteria would be of significant utility.


METHODS
Candidate components for the Noninvasive Parameters for Assessment of Cardiogenic Shock (N-PACS) criteria were required to be objective, readily available, and noninvasive. Variables encompassing hypotension, hypoperfusion, predisposing conditions, and elevated intracardiac filling pressures were optimized versus a PAC-based standard in a retrospective developmental cohort of 122 patients with acute myocardial infarction (AMI). The finalized criteria were validated in a prospective cohort of coronary care unit patients in whom a PAC was placed for clinical indications.


RESULTS
According to invasive criteria, CS was present in 32 of 217 consecutive patients undergoing PAC. Compared to the PAC-based standard, the N-PACS criteria had a sensitivity of 96.9% (95% confidence interval (CI) 82.0-99.8), specificity of 90.8% (95% CI 85.5-94.4), positive predictive value of 64.6% (95% CI 49.4-77.4), negative predictive value of 99.4% (95% CI 96.2-100), positive likelihood ratio of 10.5 (95% CI 6.7-16.7), negative likelihood ratio of 0.03 (95% CI 0.00-0.24), and diagnostic odds ratio of 306.4. Results were similar among patients with and without AMI.


CONCLUSIONS
A simple, echocardiography-based set of noninvasive diagnostic criteria can be used to accurately diagnose CS.
MedStar Heart Institute, MedStar Washington Hospital Center, USA cooperh@verizon.net.
Howard A
HA
Cooper
MedStar Heart Institute, MedStar Washington Hospital Center, USA.
Amir H
AH
Najafi
MedStar Heart Institute, MedStar Washington Hospital Center, USA.
Kambiz
K
Ghafourian
Department of Medicine, University of Texas, USA.
Andre Rm
AR
Paixao
Department of Internal Medicine, Tufts University, USA.
Mohamed
M
Aljaabari
Critical Care Medicine Department, National Institutes of Health, USA.
Micaela
M
Iantorno
Center for Devices and Radiological Health, Food and Drug Administration, USA.
Daniel
D
Caños
MedStar Heart Institute, MedStar Washington Hospital Center, USA.
Federico M
FM
Asch
Westchester Medical Center, New York Medical College, USA.
Julio A
JA
Panza
D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000175:diagnosis* / Q000503:physiopathology
Shock; diagnosis; echocardiography