Abstract 4140348: Characterization of Isolated Right Ventricular Congestion in Cardiogenic Shock

Introduction: Right ventricular (RV) congestion has been associated with poor outcomes in cardiogenic shock (CS); however, the clinical profile of pts with CS&isolated RV congestion has been less well characterized. We aimed to describe the severity of illness, resource utilization&mortality in pts with isolated RV congestion compared to other congestive profiles. Methods: The Critical Care Cardiology Trials Network is a multicenter registry of CICUs coordinated by the TIMI Study Group (Boston, MA). Pts with CS with invasive hemodynamic assessment within 24h of CICU admission (2018-2023)&not on mechanical circulatory support (MCS) at the time were included. Congestive profiles were defined by right atrial pressure (RAP)&pulmonary capillary wedge pressure (PCWP): isolated RV (RAP≥12&PCWP<18); isolated left ventricular (LV: RAP<12&PCWP≥18); biventricular (BiV: RAP≥12&PCWP≥18), and non-congested (NC: RAP<12&PCWP<18). Results: Of 2121 pts with CS, 1186 (56%) met the inclusion criteria with 7.1% classified as RV congestion, 61.6% as BiV, 18.5% as LV&12.7% as NC. The RV group was more likely to be female&have pulmonary disease than others&less likely to have prior HF or severe valve disease than LV&BiV. The RV congestion group had lower pulmonary artery pulsatility index&higher pulmonary vascular resistance than LV&NC (p<0.05 for all); MAP&CI were similar across groups. PE was a contributor to CS in 1.2% and pHTN in 13.1% of RV cases. The RV group more often presented with de novo HF-CS, where BiV&LV more often had acute on chronic HF-CS. The RV group tended to have worse shock severity by SOFA score, lactate, vasoactive-inotropic score (global p<0.05 for all)&SCAI stage (panel A) and was more likely to have a cardiac arrest (p=0.010). The RV group had greater use of mechanical ventilation&renal replacement, but lower use of MCS (panel B). CICU mortality was significantly higher in the RV group compared to other profiles (panel C), including after adjustment for cardiac arrest&CS etiology. Conclusion: In pts with CS, isolated RV congestion was associated with the highest presenting illness severity, resource utilization&mortality when compared to other congestive profiles.