Identifying Right Ventricular Dysfunction Increases the Predictive Value of SCAI Staging: A Case for an ‘R’ Modifier

Purpose Despite increasing impetus for the use of pulmonary artery catheters in cardiogenic shock (CS), the prognostic utility of identifying right ventricular dysfunction (RVD) has not been established. We aimed to evaluate the hemodynamic profiles of CS patients of varying etiology and shock stage, and identify relationships between RVD and outcomes. Methods We utilized the Cardiogenic Shock Working Group - a large, multicenter registry of inpatients with CS that is agnostic of devices and/or therapies used - to analyze the association between baseline hemodynamics and in-hospital mortality. Patients were grouped according to etiology, retrospectively determined SCAI stage, and the presence of either RVD or severe RVD. Results 1369 patients were included in the analysis. 431 patients (31.4%) died while 938 patients (68.6%) survived. Non-survivors had increased RAP (16.6 vs 13.2mmHg, p Conclusion RVD is significantly associated with increased mortality in CS across multiple etiologies and SCAI stages, although this effect is diluted in very severe CS. Identification of patients with RVD is vital to ensuring identification of ‘at-risk’ patient subsets and appropriate escalation of therapy.