Correlation between Quantitative Coronary Angiography and Intravascular Ultrasound for Non-Culprit Intermediate Coronary Lesions in Acute Coronary Syndromes
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- Category: Vol. 85, June 2017
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Correlation between Quantitative Coronary Angiography and Intravascular Ultrasound for Non-Culprit Intermediate Coronary Lesions in Acute Coronary Syndromes, FAROUK M. FARES, AKRAM M. ABD ELBARY, AHMED H. MOWAFI, MOHAMED A. SHAWKY and HELMY H. ELGHAWABY
Abstract
Introduction: The value of central venous oxygen satura-tion (ScVO2) in sepsis has been established, however, its role in severe heart failure/cardiogenic shock remains to be deter-mined.
Aim of Work: To evaluate ScVO2 as a prognostic indicator and a diagnostic tool to guide therapy in patients with severe heart failure/cardiogenic shock.
Patients and Methods: ScVO2 was prospectively assessed in 40 consecutive acute heart failure/cardiogenic shock patients. ScVO2, lactate and oxygen extraction were compared between survivors and non-survivors on admission, after 24 hours of therapy and before discharge/death. All data were statistically analyzed.
Results: Admission ScVO2 did not differ between survi-vors & non-survivors (51.99±7.05 vs. 47.51±7.06 respectively), but lactate was significantly lower in survivors (2.75±0.39 vs. 4.45±2.58; p=0.01). After 24 hours of therapy, ScVO2 increased in survivors vs. non-survivors (73.55±3.07 vs. 56.55 ±5.49; p<0.001). Before discharge/death, ScvO2 was signifi-cantly higher in survivors than non-survivors (70.2±2.61 vs. 52.8±6.09; p<0.0001). It showed a significant positive corre-lation with LVEF (R:0.36, p-value 0.01). At 24 hours of therapy, ScVO2, lactate and oxygen extraction were indepen-dent predictors of mortality. A cut-off value of ScvO2 of 66% was predictive of mortality after 24 hrs (sensitivity 100% and specificity 100% p<0.001).
Conclusions: In severe heart failure, ScVO2 is a valuable marker to guide therapy and predict mortality. Values less than 66%, or that fails to rise 23% after 24 hrs. of therapy is a marker of poor outcome.