RESUMEN
BACKGROUND: Studies had previously identified three cardiogenic shock (CS) phenotypes (cardiac-only, cardiorenal, and cardiometabolic). Therefore, we aimed to understand better the hemodynamic profiles of these phenotypes in acute myocardial infarction-CS (AMI-CS) using pulmonary artery catheter (PAC) data to better understand the AMI-CS heterogeneity. METHODS: We analyzed the PAC data of 309 patients with AMI-CS. The patients were classified by SCAI shock stage, congestion profile, and phenotype. In addition, 24 h hemodynamic PAC data were obtained. RESULTS: We identified three AMI-CS phenotypes: cardiac-only (43.7%), cardiorenal (32.0%), and cardiometabolic (24.3%). The cardiometabolic phenotype had the highest mortality rate (70.7%), followed by the cardiorenal (52.5%) and cardiac-only (33.3%) phenotypes, with significant differences (p < 0.001). Right atrial pressure (p = 0.001) and pulmonary capillary wedge pressure (p = 0.01) were higher in the cardiometabolic and cardiorenal phenotypes. Cardiac output, index, power, power index, and cardiac power index normalized by right atrial pressure and left-ventricular stroke work index were lower in the cardiorenal and cardiometabolic than in the cardiac-only phenotypes. We found a hazard ratio (HR) of 2.1 for the cardiorenal and 3.3 for cardiometabolic versus the cardiac-only phenotypes (p < 0.001). Also, multi-organ failure, acute kidney injury, and ventricular tachycardia/fibrillation had a significant HR. Multivariate analysis revealed that CS phenotypes retained significance (p < 0.001) when adjusted for the Society for Cardiovascular Angiography & Interventions score (p = 0.011) and ∆congestion (p = 0.028). These scores independently predicted mortality. CONCLUSIONS: Accurate patient prognosis and treatment strategies are crucial, and phenotyping in AMI-CS can aid in this effort. PAC profiling can provide valuable prognostic information and help design new trials involving AMI-CS.
RESUMEN
Preeclampsia is defined as elevation of blood pressure and any of the following severity criteria: proteinuria, thrombocytopenia, elevation of creatinine in the absence of another renal pathology, elevation of transaminases, pulmonary edema, or neurological symptoms. However, after 20 weeks of gestation in a previously normotensive patient, cases of preeclampsia associated with molar pregnancy have been described in patients at less than 20 weeks of gestation. A 26-year-old woman, at 14.1 weeks of gestation was admitted to the lower extremities with facial edema, holocranial headache, nausea, epigastralgia, phosphenes, and photophobia, with a double-length uterine fundus for gestational age and ultrasonography. Obstetricians who showed images of snowflakes without fetuses and annexes had multiple thecal-lutein cysts. Atypical preeclampsia was identified using the severity data for complete hydatidiform moles. Given the possibility of serious complications that may endanger the life of the maternal-fetal binomial, atypical forms of preeclampsia should be suspected.
