Right ventricular dysfunction as a mortality determinant for patients with cardiogenic shock induced by acute myocardial infarction

Daoulah A 1 , Seraj S 2 , Elmahrouk A , Yousif N 3 , Panduranga P 4 , Almahmeed W 5 Show all authors , Arabi A 6 , Alshehri M 7 , Aloui HM 8 , Arafat AA , Qutub MA 9 , Alharbi W 10 , Rajan R 11 , Kahin MA 12 , Alenezi A 13 , Al Maashani S 14 , Hassan T 15 , Alswuaidi J 6 , Alqahtani A 6 , Aldossari MA 8 , Al Jarallah M 11 , Alshehri A 16 , Elganady A , Alzahrani B 17 , Alqahtani AM 18 , Al Nasser FOM 19 , Amin H 3 , Alama MN 9 , Aldossari A 18 , Al Obaikan S 20 , Almarghany AA 21 , Kanbr O 22 , Jamjoom A 1 , Elmahrouk Y 23 , Abdulhabeeb IAM 24 , Balghith M 25 , Hersi AS 10 , Al Rawahi ASM 4 , Alkholy MAEA 4 , Hussien AF 26 , Almoghairi A 17 , Alama MMA 9 , Ghani MA 19 , Alhussini AU 8 , Basardah A 10 , Alshehri B 17 , AlObaid L , Sasti SS 27 , Abualnaja S 26 , Chachar TS 3 , Khan H 5 , Hashmani S 5 , Ghonim AA 9 , Almerri K 13 , Alsofayan RW 18 , Shawky AM , Lotfi A 2

Affiliations 

  • 1 Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
  • 2 Department of Cardiovascular Medicine, University of Massachusetts Chan Medical School - Baystate Medical Center, Springfield, Massachusetts, USA 01199
  • 3 Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Kingdom of Bahrain
  • 4 Department of Cardiology, National Heart Center, Royal Hospital, Muscat, Sultanate of Oman
  • 5 Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, UAE
  • 6 Department of Cardiology, Hamad Medical Corporation, Doha, Qatar
  • 7 Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Kingdom of Saudi Arabia
  • 8 Heart Health Center, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
  • 9 Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
  • 10 Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Kingdom of Saudi Arabia
  • 11 Department of Cardiology, Sabah Al Ahmad Cardiac Center, Al Amiri Hospital, Sharq, Kuwait
  • 12 Department of Cardiology, International Medical Center, Jeddah, Kingdom of Saudi Arabia
  • 13 Department of Cardiology, Chest Diseases Hospital, Sabah Medical Area, Shuwaikh, Kuwait
  • 14 Department of Cardiology, Salalah Heart Center, Sultan Qaboos Hospital, Salalah, Oman
  • 15 Department of Cardiology, Bugshan General Hospital, Jeddah, Kingdom of Saudi Arabia
  • 16 Department of Cardiology, College of Medicine, King Khalid University, Abha, kingdom of Saudi Arabia
  • 17 Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
  • 18 Department of Cardiology, King Salman Heart Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
  • 19 Department of Cardiology, Madinah Cardiac Center, Madinah, kingdom of Saudi Arabia
  • 20 Department of Anesthesia, King Abdulaziz medical City, National Guard Health affairs, Riyadh, Kingdom of Saudi Arabia
  • 21 Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
  • 22 Faculty of Medicine, Elrazi University, Khartoum, Sudan
  • 23 Faculty of Medicine, Tanta University, Tanta, Egypt
  • 24 Department of Cardiology, King Abdulaziz Specialist Hospital, Al Jawf, Kingdom of Saudi Arabia
  • 25 King Abdulaziz Cardiac Center, College of Medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, kingdom of Saudi Arabia
  • 26 Department of Cardiology, Kings College London Hospital, Jeddah, Kingdom of Saudi Arabia
  • 27 Department of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
Shock, 2025 Mar 03.
PMID: 40101947 DOI: 10.1097/SHK.0000000000002583

Abstract

BACKGROUND: Cardiogenic shock (CS) secondary to acute myocardial infarction (AMI) is a major cause of in-hospital mortality. With the addition of right ventricular dysfunction (RVD), it is associated with poorer outcomes. This study examines the impact of RVD on mortality in CS-AMI patients, highlighting the importance of early RVD identification and tailored management.

METHODS: Data from the Gulf Cardiogenic Shock (Gulf-CS) registry-a multicenter registry of CS-AMI patients from six Gulf countries-were analyzed to compare in-hospital and long-term outcomes for patients with and without RVD. RVD was defined by echocardiographic criteria: TAPSE <17 mm, S' wave <12 cm/s, and TAPSE/PASP ratio < 0.34. Multivariable logistic and Cox regression models were used to identify in-hospital and follow-up mortality predictors.

RESULTS: Among 1,513 CS-AMI patients, RVD was independently associated with higher in-hospital mortality (55.87% vs. 42.89%, p < 0.001) and lower survival at 6, 12, 18, and 24 months (58%, 35%, 18%, and 6% vs. 73%, 53%, 38%, and 30%; p < 0.001). Predictors of in-hospital mortality included advanced SCAI shock stage, cardiac arrest, age, NSTEMI, number of vessels affected, and elevated creatinine, while follow-up mortality was associated with advanced SCAI stage, reduced LVEF, elevated BUN, history of CABG and comorbidities including COPD and prior CVA.

CONCLUSION: RVD is a significant independent predictor of both in-hospital and long-term mortality in CS-AMI, highlighting the need for early RVD assessment and specific interventions. This study's findings support the integration of RV-focused management strategies to improve survival outcomes in this high-risk population.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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