Impact of right ventricular dysfunction on mortality in adults with cardiac arrest undergoing coronary angiogram.

Abstract

We sought to identify the impact of echocardiographic right ventricular (RV) systolic dysfunction on mortality in adults with cardiac arrest (CA). The study population included 147 adults hospitalized with CA who underwent both echocardiogram and coronary angiogram at an academic tertiary medical center. The primary outcome of interest was all-cause in-hospital mortality. Of the 147 patients studied, 20 (13.6%) had evidence of RV systolic dysfunction while 127 (86.4%) did not. Patients with RV dysfunction had higher rates of prior surgical and percutaneous coronary revascularization. They also had higher rates of mechanical ventilation, therapeutic hypothermia, vasopressor and inotrope use, and a trend towards higher rates of mechanical support. Coronary angiogram revealed higher rates of multivessel disease, right coronary artery intervention, and glycoprotein IIb-IIIa inhibitor use in those with RV dysfunction, alongside with lower echocardiographic left ventricular ejection fraction. In-hospital mortality rates were higher in adults with RV dysfunction compared to those without (55% vs 11%, p < 0.001). In multivariate analysis, RV dysfunction was the strongest independent predictor of higher mortality [odds ratio 4.71, 95% confidence interval 1.27-17.50]. In this observational contemporary study, RV dysfunction was independently associated with higher mortality in adults with CA undergoing coronary angiogram. RV dysfunction may be useful for risk stratification and management in this high-mortality population.