Study Design and Patient Cohort
We retrospectively evaluated consecutive patients admitted to the
coronary care unit at a single academic tertiary care center from
October 2013 to March 2016. Patients were included if they had a prior
diagnosis of HFrEF (left ventricular ejection fraction <40%),
and CS. CS was defined as pulmonary capillary wedge pressure
(PCWP)>15 mmHg, cardiac index <2.2, and sustained
systolic blood pressure <90 mmHg or the need for vasopressor
use. Patients were included in the study if they met the above
hemodynamic inclusion criteria and had adequate echocardiographic images
for the calculation of RAVI/LAVI. Baseline characteristics and hospital
data were obtained from the Clinical Data Repository and chart review.
Patients with a diagnosis of CS in the post-operative setting, after
myocardial infarction, or with concomitant sepsis were excluded. The
cohort was then stratified by the median RAVI/LAVI, as well as RAVI/LAVI
quartiles in order to analyze the relationship between RAVI/LAVI with
clinical outcomes. The primary outcome was death or implantation of
LVAD. The study was approved by the institutional review board of the
University of Virginia.