1. Right Ventricular Dysfunction Is Common and Identifies Patients at Risk of Dying in Cardiogenic Shock
- Author
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Claudius Mahr, Navin K. Kapur, Shashank S. Sinha, Paulina Baca, James M. McCabe, Esther Vorovich, Kay Everett, Benjamin Schwartz, Jacob Abraham, Katherine L. Thayer, Evan H. Whitehead, Anuradha Lala, Detlef Wencker, Mohit Pahuja, Neil M. Harwani, A. Reshad Garan, Manreet Kanwar, Pankaj Jain, Daniel Burkhoff, Maithri Goud, Jaime A Hernandez-Monfort, and Tara L. Jones
- Subjects
Heart Failure ,medicine.medical_specialty ,business.industry ,Ventricular Dysfunction, Right ,Cardiogenic shock ,Shock, Cardiogenic ,Central venous pressure ,Hemodynamics ,medicine.disease ,Internal medicine ,Heart failure ,Shock (circulatory) ,medicine.artery ,Pulmonary artery ,Ventricular Function, Right ,medicine ,Cardiology ,Humans ,Pulmonary Wedge Pressure ,Myocardial infarction ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Pulmonary wedge pressure ,business ,Retrospective Studies - Abstract
Background Understanding the prognostic impact of right ventricular dysfunction (RVD) in cardiogenic shock (CS) is a key step toward rational diagnostic and treatment algorithms and improved outcomes. Using a large multicenter registry, we assessed (1) the association between hemodynamic markers of RVD and in-hospital mortality, (2) the predictive value of invasive hemodynamic assessment incorporating RV evaluation, and (3) the impact of RVD severity on survival in CS. Methods and Results Inpatients with CS owing to acute myocardial infarction (AMI) or heart failure (HF) between 2016 and 2019 were included. RV parameters (right atrial pressure, right atrial/pulmonary capillary wedge pressure [RA/PCWP], pulmonary artery pulsatility index [PAPI], and right ventricular stroke work index [RVSWI]) were assessed between survivors and nonsurvivors, and between etiology and SCAI stage subcohorts. Multivariable logistic regression analysis determined hemodynamic predictors of in-hospital mortality; the resulting models were compared with SCAI staging alone. Nonsurvivors had a significantly higher right atrial pressure and RA/PCWP and lower PAPI and RVSWI than survivors, consistent with more severe RVD. Compared with AMI, patients with HF had a significantly lower RA/PCWP (0.58 vs 0.66, P = .001) and a higher PAPI (2.71 vs 1.78, P Conclusions RVD is associated with poor outcomes in CS, with key differences across etiology and shock severity. Further studies are needed to assess the usefulness of RVD assessment in guiding therapy.
- Published
- 2021