Increasing Severity of Right Ventricular Dysfunction is Associated with More Severe Cardiogenic Shock and Mortality
Presenter
Pankaj Jain, MBBS, Tufts Medical Center, Boston, MA
Paulina Baca, MS1, Pankaj Jain, MBBS1, Maithri Goud, BA1, Katherine Thayer, MPH1, Claudius Mahr2, Manreet Kanwar, MD3, Jaime Hernandez-Montfort, MD MPH MSc4, Shashank Sinha, MD, MSc5, A. Reshad Reshad Garan, MD6, 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)Allegheny General Hospital, Pittsburgh, MA, (4)Baylor Scott & White Clinic - Temple, Round Rock , TX, (5)Inova Health System, Falls Church, VA, (6)Beth Israel Deaconess Medical Center, Boston, MA, (7)Cardiovascular Research Foundation, New York, NY
Keywords: Cardiogenic shock and Heart Failure
Background
Currently, the incidence and clinical impact of right ventricular dysfunction (RVD) in Cardiogenic Shock (CS) is not completely understood. This is due to the complexity and poor accuracy of indexing the non-invasive and invasive assessments of RV function. We aimed to investigate the incidence of RVD using hemodynamic variables in patients with CS with different etiologies and the association of SVR with severe CS.
Methods
Out of 1,565 CS patients from the Cardiogenic Shock Working Group (CSWG), 717 had available data to assign SCAI stages using a previously validated method to determine CS severity. Patients were also assigned to either no RVD, RVD or severe RVD using previously validated methods. The distribution of RVD severity was analyzed across SCAI stages to determine the effect of RVD and CS severity mortality.
Results
The distribution of RVD in the overall study population was as follows: no RVD (N=500, 69.7%), RVD (N=132, 18.4%), and severe RVD (n=85, 11.9%). When stratified by SCAI stage, RVD was associated with reduced survival in SCAI stage C (p=0.01) and D (p=0.04), but nit stage E (p=0.20)
Conclusions
RVD parameters are significantly associated with mortality in CS across multiple etiologies and SCAI stages. Discerning patients with RVD is important in the clinical setting to ensure the accurate therapy and differentiation of patient subsets.
