What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure (n=2450). Intervention: Right ventricular dysfunction (RVD) severity vs. Lesser degree of RVD or normal RV function. Primary outcome: All-cause in-hospital mortality (OR 1.30, 95% CI 1.15-1.47, p=<0.001).

What question did this study set out to answer?

This study evaluates the impact of right ventricular dysfunction on mortality in patients with heart failure and cardiogenic shock.

April 30, 2026International Journal of Heart Failure1 citationsOpen Access

Right Ventricular Function and Mortality in Critically Ill Patients With Heart Failure and Cardiogenic Shock

Q: What are the key findings of this study?

Right ventricular dysfunction severity was incrementally associated with higher in-hospital mortality (OR 1.30 per degree of RVD) in cardiac intensive care unit patients with heart failure.

Q: What question did this study set out to answer?

This study evaluates the impact of right ventricular dysfunction on mortality in patients with heart failure and cardiogenic shock.

KLKirsten LippsMayo Clinic GDGarima DahiyaUniversity of Minnesota MJMaan JokhadarAdult Congenital Heart Disease

Key Result

Right ventricular dysfunction severity was incrementally associated with higher in-hospital mortality (OR 1.30 per degree of RVD) in cardiac intensive care unit patients with heart failure.

Key Points

This study evaluates the impact of right ventricular dysfunction on mortality in patients with heart failure and cardiogenic shock.
Conducted a retrospective cohort study of patients with heart failure admitted to the Mayo Clinic CICU from 2007-2018 who had a TTE within one day of admission.
TTE-derived global assessment of RV function was graded semi-quantitatively.
Outcomes measured included in-hospital and one-year mortality.
75.7% of 2,450 patients had right ventricular dysfunction, with 36.9% classified as moderate/severe.
Short-term mortality increased with RVD severity (adjusted odds ratio, 1.30 per degree of RVD; 95% CI, 1.15-1.47; p<0.001).
One-year mortality increased with RVD severity (adjusted hazard ratio, 1.21 per degree of RVD; 95% CI, 1.14-1.28; p<0.001).

Study Design

Type

Cohort (n=2,450)

Multicenter

Structured PICO

Does right ventricular dysfunction severity predict in-hospital and one-year mortality in critically ill patients with heart failure?

Population

2,450 patients with heart failure admitted to the Mayo Clinic cardiac intensive care unit (2007-2018) who had a transthoracic echocardiogram within one day of admission, median age 71.6 years, 38.4% female, 91.2% White, 25.2% with cardiogenic shock.

Intervention

Presence and severity of right ventricular dysfunction (RVD) assessed by transthoracic echocardiogram (TTE)

Comparator

Mild or no right ventricular dysfunction

Outcome

In-hospital and one-year mortalityhard clinical

In critically ill patients with acute heart failure, right ventricular dysfunction severity assessed by echocardiography is strongly associated with increased short-term and one-year mortality.

Main Result

Effect estimate: OR 1.30 (95% CI 1.15-1.47)

p-value: p=<0.001

Limitations

Retrospective design limits evaluation of causal relationships
Single-center study with predominantly White male population may affect external validity
Potential selection bias as only patients with a TTE within one day of admission were included
Unable to ascertain the specific etiology of RV dysfunction
Subjectivity in assessing RV function by bedside TTE
Unable to determine the level of physiologic support at the time of TTE

Abstract

Background and Objectives: Right ventricular dysfunction (RVD) is associated with poor prognosis in patients with acute heart failure (HF), including cardiogenic shock (CS). We evaluated the association of RVD by transthoracic echocardiogram (TTE) with mortality in cardiac intensive care unit (CICU) patients with HF. Methods: We conducted a retrospective cohort of patients with HF admitted to the Mayo Clinic CICU (2007-2018) who had a TTE within one day of admission. TTE-derived global assessment of right ventricular (RV) function was graded on a semi-quantitative scale. Outcomes included in-hospital and one-year mortality. Results: Among 2,450 patients (median 71.6 years, 38.4% female, 91.2% White), 75.7% had RVD (36.9% moderate/severe RVD). Global assessment of RVD correlated with advanced Doppler hemodynamics. Short-term mortality increased according to RVD severity (adjusted odds ratio, 1.30 per degree of RVD; 95% confidence interval CI, 1.15-1.47, p<0.001), with similar findings after stratification by left ventricular function and CS (25.2% of the cohort). One-year mortality increased with RVD severity (adjusted hazard ratio, 1.21 per degree of RVD; 95% CI, 1.14-1.28, p<0.001). Severe RVD was associated with 51.2% one-year mortality (median survival 9.9 months). Patients with moderate/severe RVD without CS had similar mortality to those with mild/no RVD with CS. Conclusions: RVD is common among CICU patients with acute HF, and TTE-derived global assessment of RV function correlates with advanced Doppler hemodynamics. RVD severity by global assessment is associated with higher short- and long-term mortality, highlighting the potential utility of point-of-care ultrasound for risk stratification in CICU patients.

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