دورية أكاديمية
Relationship between the mixed venous-to-arterial carbon dioxide gradient and the cardiac index in acute pulmonary embolism.
العنوان: | Relationship between the mixed venous-to-arterial carbon dioxide gradient and the cardiac index in acute pulmonary embolism. |
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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. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.) |
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 |
تدمد: | 2048-8734 |
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DOI: | 10.1093/ehjacc/zuae031 |