Integration of Right Ventricular Systolic and Diastolic Function With Invasive Cardiac Output: Association with Renal Replacement Therapy in Ischemic Cardiogenic Shock.

OBJECTIVE

To investigate echocardiographic parameters of right ventricular (RV) systolic and diastolic function associated with renal replacement therapy (RRT) in acute myocardial infarction complicated by cardiogenic shock (AMI-CS).

DESIGN, SETTING, AND PARTICIPANTS: Post hoc exploratory analysis of 43 prospectively identified patients admitted to a tertiary cardiac intensive care unit in London, UK, with AMI-CS.

INTERVENTIONS

Comprehensive transthoracic echocardiographic, clinical, and hemodynamic data were collected concurrently. Patients were classified based on their need for RRT.

MEASUREMENTS AND MAIN RESULTS

Median age was 61 (interquartile range: 52, 67 years), with predominantly male participants (84%). RRT for acute kidney injury was necessary in 33% (14/43) of patients. Patients requiring RRT had significantly worse RV systolic and diastolic function, reflected by 31% lower tricuspid annulus systolic velocity (RV S', 9 v 13 cm/s, p = 0.001), 19% lower late diastolic velocity (RV a', 13 v 16 cm/s, p = 0.007), and a 19% reduced invasive native cardiac output (CO; 4.3 v 5.3 L/min, p = 0.03). RV S' emerged as the strongest parameter associated with RRT (odds ratio [OR] 0.68, p = 0.006, area under the curve [AUC] = 0.80, cutoff 10.5 cm/s), followed by RV a' (OR 0.84, p = 0.02, AUC = 0.76, cutoff of 14 cm/s), and invasive native CO (OR 0.47, p = 0.02, AUC = 0.75, cutoff of 5 L/min). Combining RV S', RA a', and CO improved the diagnostic accuracy (AUC = 0.87).

CONCLUSION

These results indicate that impaired RV systolic and diastolic functions are associated with RRT in AMI-CS patients. Integrating echocardiographic and hemodynamic parameters significantly enhances diagnostic accuracy and risk stratification, potentially guiding targeted therapeutic interventions.