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

IF 3.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European Heart Journal: Acute Cardiovascular Care Pub Date : 2024-06-30 DOI:10.1093/ehjacc/zuae031
Eugene Yuriditsky, Robert S Zhang, Jan Bakker, James M Horowitz, Peter Zhang, Samuel Bernard, Allison A Greco, Radu Postelnicu, Vikramjit Mukherjee, Kerry Hena, Lindsay Elbaum, Carlos L Alviar, Norma M Keller, Sripal Bangalore
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Abstract

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.

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混合静脉-动脉二氧化碳阶差与急性肺栓塞患者心脏指数之间的关系
背景:在接受机械血栓切除术的急性肺栓塞(PE)患者中,心脏指数(CI)经常会降低,即使是临床上未出现明显休克的患者也是如此。本研究旨在描述接受机械血栓切除术的急性肺栓塞患者的混合静脉-动脉二氧化碳梯度(CO2间隙),这是灌注充分性的替代指标:这是一项单中心回顾性研究,研究对象是连续接受机械血栓切除术并同时接受肺动脉导管检查的 PE 患者,为期 3 年:结果:在 107 名患者中,97 名患者同时进行了混合静脉和动脉血气测量。51%的患者和49%的中危 PE 患者二氧化碳间隙升高(>6 mmHg)。CI降低(≤2.2 L/min/m2)与几率增加(OR = 7.9; 95% CI 3.49-18.1, p 6 mmHg)有关,血栓切除术可改善二氧化碳间隙、CI和混合静脉血氧饱和度。当二氧化碳间隙高于和低于6时,院内死亡率没有差异(9% vs. 0%;P = 0.10,HR:1.24;95% CI:0.97-1.60;P = 0.085):结论:在接受机械血栓切除术的急性 PE 患者中,近 50% 的患者二氧化碳间隙异常,且与 CI 成反比。进一步的研究应检查该人群中灌注标记物与预后之间的关系,以完善风险分层。
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来源期刊
CiteScore
8.50
自引率
4.90%
发文量
325
期刊介绍: The European Heart Journal - Acute Cardiovascular Care (EHJ-ACVC) offers a unique integrative approach by combining the expertise of the different sub specialties of cardiology, emergency and intensive care medicine in the management of patients with acute cardiovascular syndromes. Reading through the journal, cardiologists and all other healthcare professionals can access continuous updates that may help them to improve the quality of care and the outcome for patients with acute cardiovascular diseases.
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