Cardiac Power Output Predicts In-Hospital Major Adverse Cardiac Events in Patients with Acute Myocardial Infarction
Author : Y. F. Siregar, K. K. Ilyas, A. A. Siregar, H. Hasan
Upload Date : 19-04-2018
Background: Insufficient reliability of cardiac output (CO) as widely used parameter for prognosis of acute myocardial infarction (AMI) outcomes led to search for new parameters. Cardiac power output (CPO) is a novel hemodynamic measurement that represents cardiac pumping ability as compared with invasive method. The prognostic value of CPO in patients with AMI has not been examined. The aim of this study was to investigate the reliability of CPO in predicting in-hospital major cardiovascular events (MACE) using non-invasive techniques.
Method: Patients with AMI who underwent hemodynamic echocardiography less than 24 hours after admission were included. Hemodynamic data – blood pressure (BP), mean arterial pressure (MAP), CO, CPO and ejection fraction (EF) were documented. The relationship between initial CPO [(MAP x CO)/451] and in-hospital MACE was evaluated.
Results: Data were available for 64 patients (53 males, median age 56 ± 7.5). The mean CPO was 0.65 ± 0.25 W. In bivariate analysis, hospital MACE was associated CPO (OR 5.6, 95% CI 1.7-18.4, P = 0.003), Killip class (OR 2.9, 95% CI 2.1-4.1, P=0.02), HR (OR 7.8, 95% CI 1.4-41.6, P=0.007), systolic BP (OR 6.57, 95% CI 1.53-28.2, P=0.006), diastolic BP (OR 7.9, 95% CI 1.8-33.6, P=0.002), MAP (OR 2.9, 95% CI 2-4.1, P=0.02), and EF (OR 6.6, 95% CI 1.9-22.8, P=0.002). ROC curve analysis revealed that CPO had cut off point of 0.5, sensitivity of 80%, specificity of 50% and area under the curve of 0.66. This cut off point is lower than 0.53 – a cut off value previously established among patients with cardiogenic shock. Multivariate analysis showed that CPO was not the independent predictor of in-hospital MACE (OR 2.09, 95% CI 0.39-11.2, P=0.38).
Conclusion: Cardiac power output is a reliable predictor of in-hospital MACE after AMI, along with Killip class, HR, BP, MAP, and EF.
KEYWORDS : cardiac power output, ejection fraction, hemodynamic, acute myocardial infarction
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