دورية أكاديمية

Relationship between the mixed venous-to-arterial carbon dioxide gradient and the cardiac index in acute pulmonary embolism.

التفاصيل البيبلوغرافية
العنوان: Relationship between the mixed venous-to-arterial carbon dioxide gradient and the cardiac index in acute pulmonary embolism.
المؤلفون: Yuriditsky E; Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, 550 First Ave. Kimmel 15, New York, NY 10016, USA., Zhang RS; Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, 550 First Ave. Kimmel 15, New York, NY 10016, USA., Bakker J; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, NYU Grossman School of Medicine, 550 First Ave. Kimmel 15, New York, NY 10016, USA., Horowitz JM; Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, 550 First Ave. Kimmel 15, New York, NY 10016, USA., Zhang P; Department of Medicine, NYU Grossman School of Medicine, 550 First Ave. Kimmel 15, New York, NY 10016, USA., Bernard S; Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, 550 First Ave. Kimmel 15, New York, NY 10016, USA., Greco AA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, NYU Grossman School of Medicine, 550 First Ave. Kimmel 15, New York, NY 10016, USA., Postelnicu R; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, NYU Grossman School of Medicine, 550 First Ave. Kimmel 15, New York, NY 10016, USA., Mukherjee V; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, NYU Grossman School of Medicine, 550 First Ave. Kimmel 15, New York, NY 10016, USA., Hena K; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, NYU Grossman School of Medicine, 550 First Ave. Kimmel 15, New York, NY 10016, USA., Elbaum L; Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, 550 First Ave. Kimmel 15, New York, NY 10016, USA., Alviar CL; Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, 550 First Ave. Kimmel 15, New York, NY 10016, USA., Keller NM; Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, 550 First Ave. Kimmel 15, New York, NY 10016, USA., Bangalore S; Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, 550 First Ave. Kimmel 15, New York, NY 10016, USA.
المصدر: European heart journal. Acute cardiovascular care [Eur Heart J Acute Cardiovasc Care] 2024 Jun 30; Vol. 13 (6), pp. 493-500.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Oxford University Press Country of Publication: England NLM ID: 101591369 Publication Model: Print Cited Medium: Internet ISSN: 2048-8734 (Electronic) Linking ISSN: 20488726 NLM ISO Abbreviation: Eur Heart J Acute Cardiovasc Care Subsets: MEDLINE
أسماء مطبوعة: Publication: 2021- : [Oxford] : Oxford University Press
Original Publication: London : SAGE Publications, 2012-
مواضيع طبية MeSH: Pulmonary Embolism*/blood , Pulmonary Embolism*/diagnosis , Carbon Dioxide*/blood , Thrombectomy*/methods, Humans ; Male ; Female ; Retrospective Studies ; Acute Disease ; Middle Aged ; Aged ; Blood Gas Analysis/methods ; Pulmonary Artery ; Cardiac Output/physiology
مستخلص: Aims: Among patients with acute pulmonary embolism (PE) undergoing mechanical thrombectomy, the cardiac index (CI) is frequently reduced even among those without a clinically apparent shock. The purpose of this study is to describe the mixed venous-to-arterial carbon dioxide gradient (CO2 gap), a surrogate of perfusion adequacy, among patients with acute PE undergoing mechanical thrombectomy.
Methods and Results: This was a single-centre retrospective study of consecutive patients with PE undergoing mechanical thrombectomy and simultaneous pulmonary artery catheterization over a 3-year period. Of 107 patients, 97 had simultaneous mixed venous and arterial blood gas measurements available. The CO2 gap was elevated (>6 mmHg) in 51% of the cohort and in 49% of patients with intermediate-risk PE. A reduced CI (≤2.2 L/min/m2) was associated with an increased odds [odds ratio = 7.9; 95% confidence interval (CI) 3.49-18.1, P < 0.001] for an elevated CO2 gap. There was an inverse relationship between the CI and the CO2 gap. For every 1 L/min/m2 decrease in the CI, the CO2 gap increased by 1.3 mmHg (P = 0.001). Among patients with an elevated baseline CO2 gap >6 mmHg, thrombectomy improved the CO2 gap, CI, and mixed venous oxygen saturation. When the CO2 gap was dichotomized above and below 6, there was no difference in the in-hospital mortality rate (9 vs. 0%; P = 0.10; hazard ratio: 1.24; 95% CI 0.97-1.60; P = 0.085).
Conclusion: Among patients with acute PE undergoing mechanical thrombectomy, the CO2 gap is abnormal in nearly 50% of patients and inversely related to the CI. Further studies should examine the relationship between markers of perfusion and outcomes in this population to refine risk stratification.
Competing Interests: Conflict of interest: S.B.—advisory board—Abbott Vascular, Boston Scientific, Biotronik, Amgen, Pfizer, Merck, REATA, Inari, Truvic, and Argon. J.M.H.—funding from Inari Medical. The remaining authors report no conflict of interest.
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فهرسة مساهمة: Keywords: CO2 gap; Haemodynamics; Perfusion; Pulmonary embolism; Right ventricular failure; Shock
المشرفين على المادة: 142M471B3J (Carbon Dioxide)
تواريخ الأحداث: Date Created: 20240308 Date Completed: 20240629 Latest Revision: 20240629
رمز التحديث: 20240630
DOI: 10.1093/ehjacc/zuae031
PMID: 38454794
قاعدة البيانات: MEDLINE
الوصف
تدمد:2048-8734
DOI:10.1093/ehjacc/zuae031