NCSI Study: About 40% of AMICS Patients Develop Right Ventricular Dysfunction

Babar Basir, DO, discusses the latest findings on right heart dysfunction from the National Cardiogenic Shock Initiative (NCSI) study. Dr. Basir is an interventionalist at Henry Ford Hospital and one of the NCSI study co-investigators.

Dr. Basir explains that his work within the NCSI study has sought to replicate the work done by Navin Kapur, MD who looked at right ventricular dysfunction in the original SHOCK study. “Clearly we have a different sample size,” he explains. “We have patients who are treated with early mechanical support in the form of an Impella® using a shock protocol, and really early within their shock onset. We have door to balloon and door to support times that are under 95 minutes for each of the cohorts in regard to STEMI.”

Dr. Basir reports that, similar to Dr. Kapur’s work, they found that about 40% of patients with AMI cardiogenic shock ultimately develop right ventricular dysfunction, which was strictly defined as RA pressure >10, wedge to RA ratio >0.63, pulmonary artery pulsatility index (PAPi)< 2, and right ventricular stroke work index <450. In addition, they found that right ventricular dysfunction was associated with worse mortality. Patients without right ventricular dysfunction had a survival rate of around 79%. In the right ventricular dysfunction cohort, that dropped by 14 percentage points to a significantly lower survival rate of 65%.

“So really we do have to pay attention to the right ventricle in these patients,” Dr. Basir notes, “and we can’t just focus on the LV alone.”

Dr. Basir also emphasizes, “When you treat patients early with Impella, what ends up happening is that a lot of that right ventricular dysfunction resolves over the first 24 hours. And so you drop their congestion, and you actually improve their right ventricular afterload because you unload the left ventricle. And so one of the things that we’ve noticed, that I think was missing from the original SHOCK study, is that by early unloading, we actually facilitate unloading of the right ventricle in the majority of the cases.”

In concluding, Dr. Basir explains that they had four cases of pure right ventricular dysfunction. “All four patients were treated with an Impella RP® and all of those patients actually survived and did very well without needing escalation. So, another important point, we’ll have to gain more of a sample size to discuss what right ventricular hemodynamic support devices can do for our patients.”