Introduction
Cardiogenic shock (CS) is one of the most dreaded complications of chronic systolic heart failure (HF), and is marked by a state of end-organ hypoperfusion due to reduction in cardiac output. CS is defined by the hemodynamic parameters of: decreased cardiac index, hypotension, and elevated left ventricular filling pressures [1]. Despite advancements in therapeutics and mechanical support devices, patients with CS still experience excessively high mortality rates in the contemporary era.
Risk stratification of CS still remains a challenge for clinicians. HF is associated with structural remodeling due to both neurohormonal and hemodynamic perturbations [2]. It is well established that the integrity of the right ventricle (RV) is a key determinant of prognosis in HF with reduced left ventricular ejection fraction (HFrEF) [3]. Further, right atrial (RA) volume and size is an important indicator of RV remodeling. Prior studies have shown that an increased RA volume is an independent predictor of adverse outcomes in patients with HF [4,5]. It has also been shown that the ratio of right atrial volume index (RAVI) to left atrial volume index (LAVI), RAVI/LAVI, is associated with adverse outcomes in pulmonary hypertension [6].Therefore, we hypothesized that the RAVI/LAVI, as measured by two dimensional doppler echocardiography, is independently associated with death and LVAD implantation in patients with HF presenting with CS.