1097 PREDICTORS OF WEANING FROM TEMPORARY MECHANICAL CIRCULATORY SUPPORT IN PATIENTS WITH CARDIOGENIC SHOCK

Introduction

In cardiogenic shock (CS) patients with temporary mechanical circulatory support (TMCS) the weaning process is crucial to verify patients’ myocardial recovery or device dependency. To date, there are no specific guidelines on weaning strategies.

Hypothesis

We investigated clinical predictors of successful weaning from TMCS and developed with them a novel prognostic scoring system.

Methods

Eighty CS patients (62.5 ± 11.8 years, 86.2% male, 63.7% with ACS) with Impella support were evaluated. Hemodynamic, echocardiographic and laboratory data were collected at admission (T0), 24 (T1), 48 (T2), 96 (T3) hours after TMCS implantation. CS patients were classified according to successful or unsuccessful weaning, defined as hemodynamic/myocardial recovery, and death/need for LVAD/heart transplant, respectively. Independent predictors of weaning and their discriminating cut-off values were identified. Finally, a prognostic weaning score (W-Score) was derived.

Results

Thirty-eight (47.5%) CS patients showed successful (SW-group) while 42 (52.5%) unsuccessful (UW-group) weaning from TMCS. Clinical characteristics were similar between the two groups. SW-group showed higher T1, T2, T3 LVEF (p=0.013, p=0.001, p=0.001), T1 CPO (p=0.04), T2 MAP (p=0.019) and lower T1, T2 inotropic score values (p=0.001, p=0.001), T2 HR and PCWP (p=0.01, p=0.008), T1 and T3 creatinine (p=0.018, p=0.009), lactate (p=0.009, p=0.002) and NT-proBNP (p=0.017, p=0.001). T1 LVEF, NT-proBNP and inotropic score together with T3 creatinine and lactate resulted independent predictors of SW (p<0.05). T1 LVEF ≥ 10%, T1 inotropic score ≤ 8, T1 NT-proBNP ≤ 8068 ng/L, T3 lactate ≤ 1,59 mmol/L, T3 creatinine ≤ 1,76 mg/dl identified patients with SW (overall, AUC ≥0.7, p<0.05). W-Score was developed enabling SW with a cut-off score ≥ 7 (80% sensitivity, 85% specificity, AUC 0.92, p <0.001).

Conclusions

W-Score, based on T1 LVEF/inotropic score/NT-proBNP, T3 creatinine/lactate values may be useful to identify CS patients undergoing successful weaning from TMCS.

Clinical Prediction Score for Successful Liberation from Temporary Mechanical Circulatory Support in Cardiogenic Shock Patients

BACKGROUND

In cardiogenic shock (CS) patients requiring temporary mechanical circulatory support (tMCS), assessing cardiac recovery vs the need for heart replacement therapy is critical. We developed and validated a new clinical score aimed at predicting successful tMCS liberation.

METHODS

A cohort of 80 CS patients treated with Impella support between January 2018 and December 2020 was analyzed. Hemodynamic, echocardiographic, and laboratory data were collected at baseline, 24 hours, 48 hours, and 96 hours after device insertion. Patients were classified as successfully or unsuccessfully liberated from tMCS, based on recovery vs progression to death, left ventricular assist device implantation, or heart transplant. The W score, derived using independent predictors of successful liberation, was validated in 2 cohorts: 86 CS patients at our center and 23 patients from an external center.

RESULTS

Among the 80 patients (mean age 62.5 ± 11.8 years, 63.7% acute myocardial infarction CS), 47.5% achieved successful tMCS liberation. Independent predictors included left ventricular ejection fraction, N-terminal pro-brain natriuretic peptide, and inotropic score at 24 hours, along with creatinine and lactate at 96 hours (area under the curve [AUC] ≥ 0.7, P < 0.05). The W score, using a cutoff of ≥7, demonstrated good diagnostic accuracy (AUC 0.92, sensitivity 80%, specificity 85%, P < 0.001). In validation cohorts, a score ≥7 predicted successful liberation with AUCs of 0.80 (P < 0.001) and 0.72 (P < 0.015) at the internal and external centers, respectively.

CONCLUSIONS

The W score, based on key parameters at 24 and 96 hours post-tMCS, effectively supports clinicians in identifying CS patients likely to achieve successful tMCS liberation.