Prognosis value of central venous oxygen saturation in acute decompensated heart failure

Background. Central venous oxygen saturation (ScvO(2)) provides an estimation of body oxygen consumption/delivery ratio. Its use has been suggested for monitoring treatment of patients admitted for acute decompensated heart failure (ADHF) but the optimal target value has never been clearly reported. Aims. - We aimed to address the prognostic value of ScvO(2) in ADHF requiring inotrope support. Methods. - ScvO(2) was prospectively assessed in 60 patients with ADHF requiring inotrope support (mean age 62 +/- 16 years; 45 men; left ventricular ejection fraction 25 +/- 7%) and was compared with major adverse cardiac events (MACE), defined as heart transplantation, cardiac assistance and death. Results. - MACE occurred in 22 (35%) patients (14 deaths; eight referred for heart transplantation or cardiac assistance). Admission ScvO(2) (mean 57 +/- 13%) did not differ between patients with and without MACE. At 24 hours ScvO(2) (mean 62 +/- 7%) increased only in patients without MACE (65 +/- 6% vs. 58 +/- 7%; p < 0.0001) and was associated with urine output, vena cava diameter and oxygen consumption reduction. No correlation was observed between ScvO(2) and cardiac output or catecholamine rate. Multivariable analysis showed that ScvO(2) at 24 hours remained an independent predictor of MACE. Using the optimal cut-off of 60% derived from receiver operating characteristic curves, MACE were observed in 81% of patients (17/21) with ScvO(2) <= 60% at 24 hours vs. 13% (5/39) with ScvO(2) > 60% at 24 hours. Conclusion. - In patients admitted for ADHF requiring inotrope support, ScvO(2) <= 60% despite optimal treatment is a marker of poor outcome and might be an indicator for considering more aggressive therapy. (C) 2011 Elsevier Masson SAS. All rights reserved.