Right ventricular free-wall strain-based risk stratification for temporary mechanical circulatory support in cardiogenic shock.

INTRODUCTION

Early identification of patients with cardiogenic shock (CS) who will require temporary mechanical circulatory support (MCS) remains challenging. Right ventricular (RV) dysfunction is common in CS and affects haemodynamic stability. RV free wall longitudinal strain (RV FWLS) is a sensitive marker of myocardial dysfunction, but its role in predicting MCS escalation in CS remains unclear.

METHODS

In this single-centre retrospective study, patients admitted with CS between January 2023 and December 2025 were screened. Inclusion required transthoracic echocardiography within 24 h of CS diagnosis and prior to MCS implantation. RV FWLS was measured using commercially available software. Primary outcome was temporary MCS implantation during hospitalization. Secondary outcomes included in-hospital mortality and intensive care and hospital length of stay.

RESULTS

Ninety-two patients were included; 31 (34%) required temporary MCS. Severe RV FWLS impairment (<11%) was strongly associated with temporary MCS use (OR 10.49, 95% CI 3.72-29.59). Tricuspid annular plane systolic excursion and fractional area change were not significantly associated with temporary MCS. Severe RV FWLS was linked to longer intensive care stay (21 vs 8 days, P = .003) and hospital stay (25 vs 14 days, P = .003), but not mortality. RV FWLS demonstrated moderate discrimination (area under the curve, AUC 0.74), improving with left ventricular ejection fraction (LVEF) and Sequential Organ Failure Assessment (SOFA) score (AUC 0.82). A classification and regression tree -derived algorithm using RV FWLS, SOFA score, and LVEF stratified patients into distinct risk groups with 78% overall accuracy and 95% specificity.

CONCLUSION

Integration of RV FWLS with clinical parameters may improve early risk stratification in CS.