Acute cardiac care & resuscitation
Early-Phase Trajectory of Right Ventricular Hemodynamics during Microaxial Flow Pump Support for Cardiogenic Shock
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.
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