Biventricular Function and Shock Severity Predict Mortality in Cardiac ICU Patients

Abstract Background Ventricular function, including left ventricular systolic dysfunction (LVSD), right ventricular systolic dysfunction (RVSD), and biventricular dysfunction (BVD), contribute to shock in cardiac intensive care unit (CICU) patients, but the prognostic utility remains unclear. Research Question Do patients with ventricular dysfunction have higher mortality at each Society for Cardiovascular Angiography and Intervention (SCAI) shock stage? Study Design and Methods We identified CICU patients admitted with available echocardiography data. LVSD was defined as left ventricular ejection fraction less than 40%, RVSD as moderate or greater systolic dysfunction by semi-quantitative measurement, and BVD as the presence of both. Multivariable logistic regression determined the relationship between ventricular dysfunction and adjusted in-hospital mortality as a function of SCAI stage. Results The study population included 3,158 patients with a mean age of 68.2 years (±14.6), of which 51.8% had acute coronary syndromes. LVSD was present in 22.3%, RVSD in 11.8%, and 16.4% had BVD. After adjustment for SCAI shock stage there was no difference in in-hospital mortality between patients with LVSD or RVSD and those without ventricular dysfunction (p >0.05), but BVD was independently associated with higher in-hospital mortality (adjusted HR 1.815, 95% CI 1.237-2.663, p = 0.0023). The addition of ventricular dysfunction to the SCAI staging criteria increased discrimination for hospital mortality (AUC 0.784 vs. 0.766, p Interpretation Among patients admitted to the CICU, only BVD was independently associated with higher hospital mortality. The addition of echocardiography assessment to the SCAI shock criteria may facilitate improved clinical risk stratification.