Right-sided Hemodynamics predict Mortality and Differences in Cardiogenic Shock patients caused by Acute Myocardial Infarction and Acute-on-Chronic Heart Failure
Presenter
Pankaj Jain, MBBS, Tufts Medical Center, Boston, MA
Maithri Goud, BA1, Pankaj Jain, MBBS1, Paulina Baca, MS1, Katherine Thayer, MPH1, Claudius Mahr2, Jaime Hernandez-Montfort, MD MPH MSc3, A. Reshad Reshad Garan, MD4, Manreet Kanwar, MD5, Shashank Sinha, MD, MSc6, Daniel Burkhoff, M.D., PhD7 and Navin K. Kapur, M.D., FSCAI1, (1)Tufts Medical Center, Boston, MA, (2)HCA Medical City, Seattle, WA, (3)Baylor Scott & White Clinic - Temple, Round Rock , TX, (4)Beth Israel Deaconess Medical Center, Boston, MA, (5)Allegheny General Hospital, Pittsburgh, PA, (6)Inova Health System, Falls Church, VA, (7)Cardiovascular Research Foundation, New York, NY
Keywords: Cardiogenic shock and Heart Failure
Background
Right Ventricular Dysfunction (RVD) may be a determinant of outcomes in Cardiogenic Shock (CS) patients. There are a lack of studies comparing the incidence and consequences of RVD among patients with CS due to Acute Myocardial Infarction (AMI) and Heart Failure (HF). The purpose of this study is to determine the incidence of RVD, using hemodynamic variables, in patients with CS due to MI or HF.
Methods
We analyzed procedural and hemodynamic data from the Cardiogenic Shock Working Group (CSWG), a multi-center retrospective database, from 2016-2019. CS patients were subdivided by primary diagnosis of HF or AMI; RVD severity distribution was analyzed within these subgroups. The association between in-hospital mortality with filling pressures and indices of HF were analyzed in sub-cohorts to assess the effect of hemodynamic on clinical outcomes.
Results
Survival data was available for 1,414 out of 1,565 patients in the Registry. Patient with HF and AMI had similar MAP, PCWP, an CPO. Compared to AMI, HF patients had significantly higher mPAP and PVR. Despite higher pulmonary pressures amongst HF patients, RAP was similar between the two groups, RA/PCWP was significantly lower in HF than AMI patients, and both PAPi and RVSWI were significantly higher in HF. 717 patients were classified as having either no RVD (500 patients, 69.7%), RVD (132 patients, 18.2%), or severe RVD (85 patients, 11.9%). There is a greater prevalence of RVD was associated with significantly reduced survival in each etiology subgroup. Hemodynamic data related to RV function was significantly associated with outcomes in the HF subgroup but not the AMI subgroup.
Conclusions
RVD is significantly associated with mortality in CS patients across multiple etiologies. These findings indicate the importance of identifying RVD to ensure appropriate treatment.