Abstract Background Cardiogenic shock (CS) historically complicates 5-15% of acute myocardial infarction (AMI). The most recent Society for Cardiovascular Angiography and Interventions (SCAI) Shock Classification (SSC) update combines physical examination , biochemical markers, and hemodynamic parameters to classify patients from progressively severe shock stages A-E. LUV classification, which combines LUS and LVOT-VTI measurement, evaluates important hemodynamic parameters in CS, and further improves prognostication in this setting. We sought to evaluate whether the rapid point-of-care LUV classification may help reclassify SSC and better early identify SSC A and B patients at risk in-hospital mortality. Methods This was a sinle-center, prospective cohort study conducted in a tertiary hospital in Brazil between July 2022 and February 2024. Patients eligible for inclusion were consecutive adults admitted with STEMI. LUS, LVOT-VTI, and SSC were obtained within 24 hours of hospital admission. LUS combined with LVOT-VTI (LUV) measurement was utilized to classify patients according to hemodynamic and congestion status. Patients were grouped into four profiles based on LUS and LVOT-VTI findings. LUV classification profiles were determined by: 1) evidence of lung congestion as defined by ≥3 positive zone scans and 2) evidence of hypoperfusion as defined by a low velocity time integral ≤14 cm. LUV classification A was defined as absence of lung congestion and high VTI; LUV classification B as presence of lung congestion and high LVOT-VTI; LUV classification C as absence of lung congestion and low VTI; and LUV classification D was defined as presence of lung congestion and low LVOT-VTI. The combined SCAI-LUV Classification definition is shown in Figure 1. Results We included 457 patients with mean age of 61.5 and 34.4% females. Prevalence of SSC A-E was 71.8%, 13.1%, 12.6%, 1.4%, and 0.74% respectively. Prevalence of SCAI LUV Classification A-E was 58.2%, 16.4%, 23.1%, 1.4%, and 0.74% respectively. In-hospital mortality was observed in 38 (9.4%) of patients, and there was an incremental increase in mortality with worsening SSC (A, 2.7%; B, 7.5%; C, 39.2%; D, 66.6%; E, 66.6%) and SCAI-LUV Classification (A, 0.85%; B, 1.5%; C, 31.1%; D, 66.6%; E, 66.6%). SSC and SCAI-LUV Classification area under the receiving operating characteristic (ROC) curves (AUC) for in-hospital mortality were 0.823 and 0.884, respectively. When we consider only 376 patients with SSC A and B, the AUCs were 0.621 and 0.877, respectively, with a net reclassification index of 0.106. Conclusion In the present analysis, use of the non-invasive LUV method reclassified SSC risk in 10.6% of patients with CS stages A and B. Efforts should be made to incorporate noninvasive point-of-care ultrasound into initial CS evaluations, to rapidly identify higher-risk CS patient and better tailor early initial and escalation pharmacologic and device-based therapies.SCAI-LUV Classification definition.
Machado et al. (Sat,) studied this question.