Abstract 4140348: Characterization of Isolated Right Ventricular Congestion in Cardiogenic Shock
Bibliographic record
Abstract
Introduction: Right ventricular (RV) congestion has been associated with poor outcomes in cardiogenic shock (CS); however, the clinical profile of pts with CS&isolated RV congestion has been less well characterized. We aimed to describe the severity of illness, resource utilization&mortality in pts with isolated RV congestion compared to other congestive profiles. Methods: The Critical Care Cardiology Trials Network is a multicenter registry of CICUs coordinated by the TIMI Study Group (Boston, MA). Pts with CS with invasive hemodynamic assessment within 24h of CICU admission (2018-2023)&not on mechanical circulatory support (MCS) at the time were included. Congestive profiles were defined by right atrial pressure (RAP)&pulmonary capillary wedge pressure (PCWP): isolated RV (RAP≥12&PCWP<18); isolated left ventricular (LV: RAP<12&PCWP≥18); biventricular (BiV: RAP≥12&PCWP≥18), and non-congested (NC: RAP<12&PCWP<18). Results: Of 2121 pts with CS, 1186 (56%) met the inclusion criteria with 7.1% classified as RV congestion, 61.6% as BiV, 18.5% as LV&12.7% as NC. The RV group was more likely to be female&have pulmonary disease than others&less likely to have prior HF or severe valve disease than LV&BiV. The RV congestion group had lower pulmonary artery pulsatility index&higher pulmonary vascular resistance than LV&NC (p<0.05 for all); MAP&CI were similar across groups. PE was a contributor to CS in 1.2% and pHTN in 13.1% of RV cases. The RV group more often presented with de novo HF-CS, where BiV&LV more often had acute on chronic HF-CS. The RV group tended to have worse shock severity by SOFA score, lactate, vasoactive-inotropic score (global p<0.05 for all)&SCAI stage (panel A) and was more likely to have a cardiac arrest (p=0.010). The RV group had greater use of mechanical ventilation&renal replacement, but lower use of MCS (panel B). CICU mortality was significantly higher in the RV group compared to other profiles (panel C), including after adjustment for cardiac arrest&CS etiology. Conclusion: In pts with CS, isolated RV congestion was associated with the highest presenting illness severity, resource utilization&mortality when compared to other congestive profiles.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".