Purpose: Pressure-volume (PV) analysis provides insight into ventricular mechanics but requires conductance catheters, limiting clinical use. We aimed to characterize PV responses in cardiogenic shock (CS) & MCS strategies using a bedside method combining pulmonary artery catheter (PAC)+echo data. Methods: 68 patients with CS from 4 centers in 2 countries were prospectively studied. PAC+echo were obtained at baseline --> 48 h. PV-loop variables were derived from combined PAC+echo. Bayesian posterior probabilities P(Δ>0) and % change summarized effect direction and strength. Results: AMI-CS+mAFP, MAP decreased −13 and PCWP −11.6 mmHg (P=0), while CO increased +0.99 L/min (P=1). Ea declined −1.22 mmHg/mL, LV-VAC improved −1.42 (P=0.001), and efficiency rose (P=1), plus PVA decreased −103 mmHg·mL (P=0.13). RV performance improved with PVR −3.6 WU (P=0), TAPSE +2 mm, and PAPI +2.1 (P=0.99), indicating full unloading. In HF-CS+mAFP, MAP +7 (P=0.95) and PCWP −4.5 mmHg (P=0.04) with modest CO gain (+0.3 L/min; P=0.84) and decreased Ea (−0.35 mmHg/mL; P=0.011); showing partial unloading. AMI-CS+IABP, PCWP −10.4 mmHg (P=0), Ees +0.13 mmHg/mL (P=0.98), VAC −0.42 (P=0.003), and efficiency +3.6% (P=1). HF-CS+IABP, SBP +26.7, MAP +14.3 mmHg (P>0.95), and PCWP −4.7 mmHg (P=0.004), with SW +250 mmHg·mL and OPP +18.7 mmHg (P=1), reflecting active systolic improvement. Without MCS, AMI-CS had MAP −7.4, PCWP −5.5 mmHg (P<0.05), thus ◊ limited recovery. In contrast, HF-CS showed PCWP −9.1 mmHg (P=0), CO +0.77 L/min (P=1), VAC −0.32 (P<0.05), and modest efficiency gain (+2.2 %; P=0.99), consequent of pharmacologic afterload reduction. Conclusion: Integrating PAC and echocardiography enables bedside PV-loop reconstruction. mAFP unloads; IABP improves compliance; medical therapy offers limited relief. This approach links invasive monitoring with mechanistic insight for precision management.
Bedside-Derived Pressure-Volume Loops Reveal Support Profiles in Acute Myocardial Infarction & Heart Failure Cardiogenic Shock: Microaxial Flow Pump, Intra-Aortic Balloon Pump, and No Mechanical Circulatory Support
G Gallone;P Bocchino;S Frea;A Loforte;
2026-01-01
Abstract
Purpose: Pressure-volume (PV) analysis provides insight into ventricular mechanics but requires conductance catheters, limiting clinical use. We aimed to characterize PV responses in cardiogenic shock (CS) & MCS strategies using a bedside method combining pulmonary artery catheter (PAC)+echo data. Methods: 68 patients with CS from 4 centers in 2 countries were prospectively studied. PAC+echo were obtained at baseline --> 48 h. PV-loop variables were derived from combined PAC+echo. Bayesian posterior probabilities P(Δ>0) and % change summarized effect direction and strength. Results: AMI-CS+mAFP, MAP decreased −13 and PCWP −11.6 mmHg (P=0), while CO increased +0.99 L/min (P=1). Ea declined −1.22 mmHg/mL, LV-VAC improved −1.42 (P=0.001), and efficiency rose (P=1), plus PVA decreased −103 mmHg·mL (P=0.13). RV performance improved with PVR −3.6 WU (P=0), TAPSE +2 mm, and PAPI +2.1 (P=0.99), indicating full unloading. In HF-CS+mAFP, MAP +7 (P=0.95) and PCWP −4.5 mmHg (P=0.04) with modest CO gain (+0.3 L/min; P=0.84) and decreased Ea (−0.35 mmHg/mL; P=0.011); showing partial unloading. AMI-CS+IABP, PCWP −10.4 mmHg (P=0), Ees +0.13 mmHg/mL (P=0.98), VAC −0.42 (P=0.003), and efficiency +3.6% (P=1). HF-CS+IABP, SBP +26.7, MAP +14.3 mmHg (P>0.95), and PCWP −4.7 mmHg (P=0.004), with SW +250 mmHg·mL and OPP +18.7 mmHg (P=1), reflecting active systolic improvement. Without MCS, AMI-CS had MAP −7.4, PCWP −5.5 mmHg (P<0.05), thus ◊ limited recovery. In contrast, HF-CS showed PCWP −9.1 mmHg (P=0), CO +0.77 L/min (P=1), VAC −0.32 (P<0.05), and modest efficiency gain (+2.2 %; P=0.99), consequent of pharmacologic afterload reduction. Conclusion: Integrating PAC and echocardiography enables bedside PV-loop reconstruction. mAFP unloads; IABP improves compliance; medical therapy offers limited relief. This approach links invasive monitoring with mechanistic insight for precision management.
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