Integration of Right Ventricular Systolic and Diastolic Function With Invasive Cardiac Output: Association with Renal Replacement Therapy in Ischemic Cardiogenic Shock.

Abstract

Objective: To investigate echocardiographic parameters of right ventricular (RV) systolic and diastolic function associated with renal replacement therapy (RRT) in acute myocardial infarction complicated by cardiogenic shock (AMI-CS).

Design, setting, and participants: Post hoc exploratory analysis of 43 prospectively identified patients admitted to a tertiary cardiac intensive care unit in London, UK, with AMI-CS.

Interventions: Comprehensive transthoracic echocardiographic, clinical, and hemodynamic data were collected concurrently. Patients were classified based on their need for RRT.

Measurements and main results: Median age was 61 (interquartile range: 52, 67 years), with predominantly male participants (84%). RRT for acute kidney injury was necessary in 33% (14/43) of patients. Patients requiring RRT had significantly worse RV systolic and diastolic function, reflected by 31% lower tricuspid annulus systolic velocity (RV S', 9 v 13 cm/s, p = 0.001), 19% lower late diastolic velocity (RV a', 13 v 16 cm/s, p = 0.007), and a 19% reduced invasive native cardiac output (CO; 4.3 v 5.3 L/min, p = 0.03). RV S' emerged as the strongest parameter associated with RRT (odds ratio [OR] 0.68, p = 0.006, area under the curve [AUC] = 0.80, cutoff 10.5 cm/s), followed by RV a' (OR 0.84, p = 0.02, AUC = 0.76, cutoff of 14 cm/s), and invasive native CO (OR 0.47, p = 0.02, AUC = 0.75, cutoff of 5 L/min). Combining RV S', RA a', and CO improved the diagnostic accuracy (AUC = 0.87).

Conclusion: These results indicate that impaired RV systolic and diastolic functions are associated with RRT in AMI-CS patients. Integrating echocardiographic and hemodynamic parameters significantly enhances diagnostic accuracy and risk stratification, potentially guiding targeted therapeutic interventions.