Right Ventricular Function and Mortality in Critically Ill Patients With Heart Failure and Cardiogenic Shock

Right ventricular dysfunction (RVD) is associated with poor prognosis in patients with acute heart failure (HF), including cardiogenic shock (CS). We evaluated the association of RVD by transthoracic echocardiogram (TTE) with mortality in cardiac intensive care unit (CICU) patients with HF.

We conducted a retrospective cohort of patients with HF admitted to the Mayo Clinic CICU (2007-2018) who had a TTE within one day of admission. TTE-derived global assessment of right ventricular (RV) function was graded on a semi-quantitative scale. Outcomes included in-hospital and one-year mortality.

Among 2,450 patients (median 71.6 years, 38.4% female, 91.2% White), 75.7% had RVD (36.9% moderate/severe RVD). Global assessment of RVD correlated with advanced Doppler hemodynamics. Short-term mortality increased according to RVD severity (adjusted odds ratio, 1.30 per degree of RVD; 95% confidence interval [CI], 1.15-1.47, p<0.001), with similar findings after stratification by left ventricular function and CS (25.2% of the cohort). One-year mortality increased with RVD severity (adjusted hazard ratio, 1.21 per degree of RVD; 95% CI, 1.14-1.28, p<0.001). Severe RVD was associated with 51.2% one-year mortality (median survival 9.9 months). Patients with moderate/severe RVD without CS had similar mortality to those with mild/no RVD with CS.

RVD is common among CICU patients with acute HF, and TTE-derived global assessment of RV function correlates with advanced Doppler hemodynamics. RVD severity by global assessment is associated with higher short- and long-term mortality, highlighting the potential utility of point-of-care ultrasound for risk stratification in CICU patients.