Abstract 15635: Right Ventricular Dysfunction Predicts Poor Outcomes in Cardiac Arrest Patients Independent of Left Ventricular Function
Background: Cardiac arrest remains a challenging clinical entity with a high morbidity and mortality burden. Presently, echocardiographic assessment in the peri-arrest period focuses on left ventricular (LV) function. We hypothesize that post-arrest right ventricular (RV) dysfunction predicts worse survival and neurologic outcome in cardiac arrest patients, independent of LV dysfunction.
Methods: This retrospective cohort study included 298 cardiac arrests in the Penn Alliance for Therapeutic Hypothermia Registry. LV dysfunction was defined as an LV ejection fraction ≤ 50%. A composite RV dysfunction score was based on categorical grading of RV dilation and RV systolic dysfunction. Multivariate logistic regression was completed to account for LV dysfunction and all other significant factors identified in the univariate analyses.
Results: Of the 298 patients, 57% were male and 43% were female, with a mean age of 58.7 ± 16.6 years. 185 (62%) patients had LV dysfunction, 173 (58%) had RV dysfunction, and 98 (33%) had biventricular dysfunction on the initial post-arrest echocardiogram. Mortality and poor neurologic outcome (cerebral performance category, CPC ≥ 3) were more frequent in patients with RV dysfunction (Figure). Independent of LV function, RV dysfunction was predictive of lower survival (Mild or Moderate: OR 0.38, CI 0.20-0.70, p < 0.01; Severe: OR 0.06, CI 0.02-0.21, p < 0.001) and worse neurologic outcome (Mild or Moderate: OR 0.25, CI 0.13-0.46, p < 0.001; Severe: OR 0.04, CI 0.01-0.20, p < 0.001) compared to patients with normal RV function after cardiac arrest.
Conclusions: Echocardiographic findings of post-arrest RV dysfunction were equally prevalent as LV dysfunction. RV dysfunction was significantly predictive of worse outcomes in cardiac arrest patients after accounting for LV dysfunction. In conclusion, post-arrest RV dysfunction may be useful for risk stratification and tailored management in this high-mortality population.
- © 2013 by American Heart Association, Inc.