Estimation of Stressed Blood Volume in Patients with Cardiogenic Shock from Acute Myocardial Infarction and Decompensated Heart Failure

Purpose Sympathetic activation results in a functional distribution of venous blood from the unstressed reservoir to the hemodynamically active stressed compartment. Such redistribution has been hypothesized to contribute importantly to the elevated filling pressures observed in decompensated heart failure and cardiogenic shock (CS). We recently reported a novel computational method to estimate SBV by fitting measured hemodynamic data from patients to outputs from a cardiovascular model. We hypothesized that estimated stressed blood volume (eSBV) may correlate with severity and clinical outcomes in cardiogenic shock. Methods Hemodynamic parameters including eSBV were compared among a subset of patients from the Cardiogenic Shock Working Group (CSWG) registry who had a complete set of hemodynamic data. eSBV was compared across shock etiologies (AMI vs HF-CS), SCAI stage, and between survivors and non-survivors. Results Among 528 CSWG registry patients analyzed, 25.4% had AMI-CS and 61.9% had HF-CS. Mean eSBV was 2423 ± 531 mL/70 kg (normal value ∼1500 mL) and was similar between the AMI-CS and HF-CS subgroups (2421 ± 478 vs 2342 ± 599 mL/70kg, p=0.90). eSBV increased with increasing SCAI stage (B, 2029 ± 540; C, 2305 ± 505; D, 2496 ± 507; E, 2707 ± 420 mL/70 kg, p Conclusion eSBV is a novel integrated index of congestion which correlates with shock severity. eSBV was higher in patients with HF-CS who died while no difference was observed in AMI-CS, suggesting that congestion may play a more significant role in the deterioration of patients with HF-CS.