Acute cardiac care & resuscitationCohort study
Early-Phase Trajectory of Right Ventricular Hemodynamics during Microaxial Flow Pump Support for Cardiogenic Shock
- registry study
Authors' conclusion
In patients with cardiogenic shock supported by PVAD, the early trajectory of hRVD provides prognostic information. Persistent or worsening hRVD at 24 hours identifies high-risk patients and may guide timely escalation of right-heart-targeted therapies. (UNLOADERS-PVAD [Unloading and Heart Recovery with Advanced Mechanical Circulatory Support: Optimal Management of Percutaneous Ventricular Assist Device] UMIN000052966).
Study context
- Population
- Patients with cardiogenic shock treated with percutaneous ventricular assist device (PVAD) from the UNLOADERS-PVAD registrypatients with available data
- Participants
- 463 patients
- Exposure
- Persistent or worsening hemodynamic RVD (hRVD) at 24 h post-PVAD vs other hRVD trajectories
- Outcome
- Composite of:
- All-cause mortality
- Reintroduction of mechanical circulatory support after PVAD discontinuation
- Follow-up
- Within 30 days
Main finding
As reported in the abstract
- Persistent or worsening hRVD at 24 h post-PVAD was associated with a higher risk of the primary endpoint
Observational data: associations, not effects.
Further findings
Prevalence of hRVD
- pre-PVAD
- 52% (63/121)
- early post-PVAD
- 48% (211/443)
- 24 h post-PVAD
- 39% (169/436)
hRVD trajectories
- Heterogeneous, with improvement predominating over deterioration
Follow-up
- Median follow-up from PVAD implantation
- 27 (12-30) days
Components of hRVD and adverse outcomes
- Elevated right atrial pressure associated with adverse outcomes only at 24 h post-PVAD
- Low pulmonary artery pulsatility index consistently associated with adverse outcomes across all time points
Original publication
Early-Phase Trajectory of Right Ventricular Hemodynamics during Microaxial Flow Pump Support for Cardiogenic Shock. JACC Adv. Published 19 August 2026. doi:10.1016/j.jacadv.2026.103165
Summarised from the published abstract; every number is checked against it