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.