Right Ventricular Dysfunction in Cardiogenic Shock on Temporary Mechanical Circulatory Support

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ID: 328232
2026
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Abstract
Abstract Aims Right ventricular dysfunction (RVD) is common in cardiogenic shock (CS) due to left ventricular failure and 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 Individuals with CS from the SWISS Circulatory Support Registry (NCT04117230) were included. RVD was defined by ≥1 of the following parameter: 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. Results: 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). Conclusions RVD was linked to increased mortality and worse hemodynamic 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.
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Authors Jan Estoppey, Iulia Maia Muresan, Matthias Bossard, Gregor Leibundgut, Gregor Fahrni, Stefan Blöchlinger, Roger Ludwig, Anna S. Messmer, Valentin Köchli, T Seiler, Armin Spahr, Alain Bernheim, Anna Schmidt, Florim Cuculi, Lukas Hunziker, Monika Fürholz
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Journal European Heart Journal Open
Year 2026
DOI
10.1093/ehjopen/oeag139
URL
https://doi.org/10.1093/ehjopen/oeag139
Keywords Keywords not found

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