Characteristics and Outcomes of Patients with Cardiogenic Shock and Clinically Significant Valvular Heart Disease: From the Critical Care Cardiology Trials Network.

Abstract

Background: Cardiogenic shock (CS) can be complicated by severe valvular heart disease (VHD). We analyzed cardiac intensive care unit (CICU) admissions by VHD status.

Methods and results: The Critical Care Cardiology Trials Network is a multicenter network of tertiary CICUs. Centers contributed data from consecutive admissions during 2-month annual snapshots from 2017 to 2023. CS admissions were classified as having CS attributed to VHD, CS with non-causative VHD, or CS without severe VHD. Demographics and therapies were compared. Unadjusted and adjusted odds ratios for in-hospital mortality were calculated. We analyzed 5,242 admissions with CS (4.1% attributed to VHD, 18.8% with non-causative VHD, 77.1% without severe VHD). Mitral regurgitation (32.1%) and aortic stenosis (27.9%) were the most common pathologies in CS attributed to VHD. Admissions with CS attributed to VHD more commonly had LVEF≥40% on admission (present in 62.8%, 22.6%, and 15.1%, respectively; p<0.001). Valve intervention was performed in 32.1% of those with CS attributed to VHD. Unadjusted in-hospital mortality in admissions with CS attributed to VHD was 40.0%, compared to 33.4% and 30.3% in the other groups.

Conclusions: VHD is the underlying cause of CS in a minority of CICU admissions but is associated with a high in-hospital mortality.