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Multicenter Study
. 2025 Jun 1;63(6):885-892.
doi: 10.1097/SHK.0000000000002583. Epub 2025 Mar 3.

RIGHT VENTRICULAR DYSFUNCTION AS A MORTALITY DETERMINANT FOR PATIENTS WITH CARDIOGENIC SHOCK INDUCED BY ACUTE MYOCARDIAL INFARCTION

Amin Daoulah  1 , Shaber Seraj  2 , Ahmed Elmahrouk, Nooraldaem Yousif  3 , Prashanth Panduranga  4 , Wael Almahmeed  5 , Abdulrahman Arabi  6 , Mohammed Alshehri  7 , Hatem M Aloui  8 , Amr A Arafat, Mohammed A Qutub  9 , Waleed Alharbi  10 , Rajesh Rajan  11 , Mokhtar Abdirahman Kahin  12 , Abdullah Alenezi  13 , Said Al Maashani  14 , Taher Hassan  15 , Jassim Alswuaidi  6 , Awad Alqahtani  6 , Mubarak Abdulhadi Aldossari  8 , Mohammed Al Jarallah  11 , Ali Alshehri  16 , Abdelmaksoud Elganady, Badr Alzahrani  17 , Abdulrahman M Alqahtani  18 , Faisal Omar M Al Nasser  19 , Haitham Amin  3 , Mohamed N Alama  9 , Alaa Aldossari  18 , Sultan Al Obaikan  20 , Alsayed Ali Almarghany  21 , Omar Kanbr  22 , Ahmed Jamjoom  1 , Youssef Elmahrouk  23 , Ibrahim A M Abdulhabeeb  24 , Mohammed Balghith  25 , Ahmad S Hersi  1 , Abeer Said Mohamed Al Rawahi  4 , Marwa Abd Elghany Albasiouny Alkholy  4 , Adnan Fathey Hussien  26 , Abdulrahman Almoghairi  17 , Mohamed Mohammednabil A Alama  9 , Mohamed Ajaz Ghani  19 , Ayman Uthman Alhussini  8 , Ayman Basardah  10 , Bandar Alshehri  17 , Laura AlObaid, Sara Shawki Saati  27 , Seraj Abualnaja  26 , Tarique Shahzad Chachar  3 , Hassan Khan  5 , Shahrukh Hashmani  5 , Ahmed A Ghonim  9 , Khalid Almerri  13 , Razan W Alsofayan  18 , Abeer M Shawky, Amir Lotfi  2
Affiliations
Multicenter Study

RIGHT VENTRICULAR DYSFUNCTION AS A MORTALITY DETERMINANT FOR PATIENTS WITH CARDIOGENIC SHOCK INDUCED BY ACUTE MYOCARDIAL INFARCTION

Amin Daoulah et al. Shock. .

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: tricuspid annular plane systolic excursion <17 mm, S' wave <12 cm/s, and tricuspid annular plane systolic excursion/ pulmonary artery systolic pressure 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 Society for Cardiovascular Angiography and Interventions shock stage, cardiac arrest, age, non-ST-elevation myocardial infarction, number of vessels affected, and elevated creatinine, while follow-up mortality was associated with advanced Society for Cardiovascular Angiography and Interventions stage, reduced left ventricular ejection fraction, elevated blood urea nitrogen, history of CABG and comorbidities including chronic obstructive pulmonary disease and prior cerebrovascular accident. 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.

Keywords: Cardiogenic shock; Gulf; RV dysfunction, outcomes; acute myocardial infarction.

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Conflict of interest statement

The authors report no conflicts of interest.

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