Interaction between renal and right ventricular function and their early prognostic relevance in patients with cardiogenic shock complicating AMI

Abstract Background Renal function has an important role in the pathophysiological cascade of the cardiogenic shock (CS) and the venous congestion caused by right ventricular (RV) dysfunction can lead to renal functional impairment in patients with CS complicating acute myocardial infarction (AMI). Purpose In the present study, we investigated the interaction between renal and RV function and their early prognostic relevance in patients with CS complicating AMI. Method Patients with AMI complicated by CS who underwent primary percutaneous coronary intervention (PCI) were selected. Renal function was assessed by estimated glomerular filtration rate (eGFR) at the time of admission. RV function, as assessed by RV longitudinal strain, was evaluated using the 2D-speckle tracking echocardiography within 48 hours from admission. 30-day all-cause death was chosen for early outcome measures. Results A total of 51 patients with CS complicating AMI were selected (mean age 64±14 and 77% men). After adjustment of important clinical risk factors including age, diabetes mellitus, peak troponin I, hemoglobin, admission glucose and Ee’ ratio, RV longitudinal strain was significantly associated with eGFR (β=1.50, 95% CI 0.14-2.87, p=0.032) (Figure 1A). Interaction between eGFR and RV longitudinal strain was significantly associated with 30-day mortality in the multivariable Cox proportional hazard regression model which adjusted for left ventricular (LV) global longitudinal strain (GLS) and Ee’ ratio (HR=0.99, 95% CI 0.98-1.00, p-value for interaction = 0.049). Improvement in eGFR was associated with decreased risk of death when RV longitudinal strain was inreased beyond 15% after successful primary PCI (Figure 1B). Conclusion Interaction between renal and RV function is independently associated with early outcome in patients with CS complicating AMI. RV unloading after successful primary PCI may improve renal function and early prognosis in those high-risk patients.