Biventricular Function and Shock Severity Predict Mortality in Cardiac ICU Patients

Area of Science:

• Cardiology
• Critical Care Medicine
• Echocardiography

Background:

• Ventricular dysfunction, including left (LVSD), right (RVSD), and biventricular (BVD), is common in cardiac intensive care unit (CICU) patients with shock.
• The prognostic value of different types of ventricular dysfunction in relation to shock severity remains incompletely understood.

Purpose of the Study:

• To investigate whether patients with ventricular dysfunction exhibit higher mortality rates across Society for Cardiovascular Angiography and Intervention (SCAI) shock stages.
• To determine the independent prognostic impact of LVSD, RVSD, and BVD on in-hospital mortality in CICU patients.

Main Methods:

• Retrospective analysis of 3,158 CICU patients with available echocardiography data.
• Definitions: LVSD (LVEF < 40%), RVSD (moderate/severe systolic dysfunction), BVD (both LVSD and RVSD).
• Multivariate logistic regression was used to assess the relationship between ventricular dysfunction and adjusted in-hospital mortality, stratified by SCAI shock stage.

Main Results:

• Biventricular dysfunction (BVD) was present in 16.4% of patients.
• After adjusting for SCAI shock stage, only BVD was independently associated with increased in-hospital mortality (aHR, 1.815; P = .0023).
• Incorporating ventricular dysfunction assessment into SCAI staging improved discrimination for hospital mortality (AUC 0.784 vs. 0.766).

Conclusions:

• In CICU patients with shock, only biventricular dysfunction (BVD) independently predicts higher hospital mortality.
• Echocardiographic assessment of ventricular function, particularly BVD, can enhance clinical risk stratification when used alongside SCAI shock criteria.