Journal article
Right Ventricular Dysfunction Is Common and Identifies Patients at Risk of Dying in Cardiogenic Shock
Journal of cardiac failure, v 27(10), pp 1061-1072
01 Oct 2021
PMID: 34625126
Featured in Collection : UN Sustainable Development Goals @ Drexel
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 < .001) and RVSWI (5.70 g-m/m(2) vs 4.66 g-m/m(2), P < .001), reflecting relatively preserved RV function. Paradoxically, multiple RVD parameters (PAPI, RVSWI) were associated with mortality in the HF but not the AMI cohort. RVD was more severe with advanced SCAI stage, although its prognostic value was progressively diluted in stages D and E. Multivariable modelling incorporating the RA/PCWP improved the predictive value of SCAI staging (area under the curve [AUC] 0.78 vs 0.73, P < .001), largely driven by patients with HF (AUC 0.82 vs 0.71, P < .001).
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.
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Details
- Title
- Right Ventricular Dysfunction Is Common and Identifies Patients at Risk of Dying in Cardiogenic Shock
- Creators
- Pankaj Jain - Tufts Medical CenterKatherine L. Thayer - Tufts Medical CenterJacob Abraham - Ctr Cardiovasc Tics Res & Data Sci CARDS, Portland, OR USAKay D. Everett - Tufts Medical CenterMohit Pahuja - MedStar Washington Hospital CenterEvan H. Whitehead - Massachusetts General HospitalBenjamin P. Schwartz - Tufts Medical CenterAnuradha Lala - Mount Sinai HospitalShashank S. Sinha - Inova Fairfax HospitalManreet K. Kanwar - Allegheny Health NetworkA. Reshad Garan - Beth Israel Deaconess Medical CenterJaime A. Hernandez-Monfort - Cleveland Clinic FloridaClaudius Mahr - University of WashingtonEsther Vorovich - Northwestern Memorial HospitalDetlef Wencker - Baylor Medical Center at GarlandJames M. Mccabe - University of WashingtonTara Jones - University of UtahMaithri Goud - Tufts Medical CenterPaulina Baca - Tufts Medical CenterNeil Harwani - Tufts Medical CenterDaniel Burkhoff - Cardiovascular Research FoundationNavin K. Kapur - Tufts Medical Center
- Publication Details
- Journal of cardiac failure, v 27(10), pp 1061-1072
- Publisher
- Elsevier
- Number of pages
- 12
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Cardiology
- Web of Science ID
- WOS:000709697700005
- Scopus ID
- 2-s2.0-85116586288
- Other Identifier
- 991021932101604721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems