Right ventricular dysfunction in cardiogenic shock on temporary mechanical circulatory support.

Abstract

Aims: Right ventricular dysfunction (RVD) is common in cardiogenic shock (CS) due to left ventricular failure and is associated with increased mortality, but its impact in patients requiring temporary mechanical circulatory support (tMCS) remains unclear. We explored RVD and its association with clinical outcomes in CS patients under tMCS.

Methods and results: Individuals with CS from the SWISS Circulatory Support Registry (NCT04117230) were included. RVD was defined by ≥1 of the following parameters: tricuspid annular plane systolic excursion (TAPSE) < 14 mm, TAPSE/systolic pulmonary artery pressure (sPAP) < 0.34, right atrial pressure (RAP) > 15 mmHg, RAP/pulmonary capillary wedge pressure >0.63 or pulmonary artery pulsatility index (PAPi) < 1.85. The primary endpoint was 6-month mortality; secondary endpoints were hemodynamic stabilization markers. 745 patients were included: 580 supported with left-side-Impella-devices^© (with 39 requiring concomitant second device) and 165 with VA-ECMO. RVD was more prevalent in patients on VA-ECMO compared to Impella (60% vs. 33%, P < 0.001). In Impella patients, RVD was associated with higher 6-month mortality (43% vs. 30%, P = 0.015), higher lactate levels (1.6 mmol/L vs. 1.3 mmol/L; P = 0.01), lower central venous saturation (55% vs. 61%; P = 0.005) and reduced mean arterial pressure (55 mmHg vs. 58 mmHg; P = 0.002). In VA-ECMO patients with RVD, 6-month mortality was numerically higher, without statistical significance (61% vs. 45%, P = 0.13).

Conclusion: RVD was linked to increased mortality and worse haemodynamic stabilization in patients supported with Impella, whereas this association was not demonstrated in those under VA-ECMO. RV function is a key prognostic marker in CS patients under tMCS and should be assessed to guide device selection, management, and weaning.