BACKGROUND: Currently, use of mechanical circulatory support (MCS) in non-ischaemic cardiogenic shock (CS) is predominantly guided by shock-specific markers, and not by markers of cardiac function. We hypothesise that left ventricular ejection fraction (LVEF) can identify patients with a higher likelihood to benefit from MCS and thus help to optimise their expected benefit. METHODS: Patients with non-ischaemic CS and available data on LVEF from 16 tertiary-care centres in five countries were analysed. Cox regression models were fitted to evaluate the association between LVEF and mortality, as well as the interaction between LVEF, MCS use and mortality. RESULTS: N = 807 patients were analysed: mean age 63 [interquartile range (IQR) 51.5-72.0] years, 601 (74.5%) male, lactate 4.9 (IQR 2.6-8.5) mmol/l, LVEF 20 (IQR 15-30) %. Lower LVEF was more frequent amongst patients with more severe CS, and MCS was more likely used in patients with lower LVEF. There was no association between LVEF and 30-day mortality risk in the overall study cohort. However, there was a significant interaction between MCS use and LVEF, indicating a lower 30-day mortality risk with MCS use in patients with LVEF ≤ 20% (hazard ratio 0.72, 95% confidence interval 0.51-1.02 for LVEF ≤ 20% vs. hazard ratio 1.31, 95% confidence interval 0.85-2.01 for LVEF > 20%, interaction-p = 0.017). CONCLUSION: This retrospective study may indicate a lower mortality risk with MCS use only in patients with severely reduced LVEF. This may propose the inclusion of LVEF as an adjunctive parameter for MCS decision-making in non-ischaemic CS, aiming to optimise the benefit-risk ratio.

Cardio Center Humanitas Clinical and Research Center IRCCS Rozzano Milan Italy

Department of Cardiology and Angiology University Heart Center Freiburg Bad Krozingen Freiburg Germany

Department of Cardiology and Vascular Medicine West German Heart and Vascular Center University Hospital Essen Essen Germany

Department of Cardiology AZ Sint Lucas Ghent Belgium

Department of Cardiology Charité Universitätsmedizin Berlin Campus Benjamin Franklin Berlin Germany

Department of Cardiology IKEM Prague Czech Republic

Department of Cardiology Paracelsus Medical University Nürnberg Nuremberg Germany

Department of Cardiology University Heart and Vascular Center Hamburg Martinistr 52 20251 Hamburg Germany

Department of Intensive Care Medicine University Medical Center Hamburg Eppendorf Hamburg Germany

Department of Internal Medicine 1 University Hospital Jena Jena Germany

Department of Internal Medicine 1 University Hospital Würzburg Würzburg Germany

Department of Internal Medicine and Cardiology Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute Leipzig Germany

Department of Medicine 1 University Hospital LMU Munich Munich Germany

Department of Perioperative Medicine St Bartholomew's Hospital London UK

Dept Cardiothoracic and Vascular Anesthesia and Intensive Care AO SS Antonio E Biagio E Cesare Arrigo Alessandria Italy

Division of Cardiology Pulmonology and Vascular Medicine Medical Faculty University Duesseldorf Duesseldorf Germany

German Center for Cardiovascular Research Partner Site Hamburg Kiel Lübeck Hamburg Germany

Herzzentrum Dresden Technische Universität Dresden Dresden Germany

IRCCS S Maria Nascente Fondazione Don Carlo Gnocchi ONLUS Milan Italy

Medizinische Klinik 2 Kliniken Nordoberpfalz AG Weiden Germany

Unità Di Cure Intensive Cardiologiche and De Gasperis Cardio Center ASST Grande Ospedale Metropolitano Niguarda Milan Italy

University Heart Center Lübeck University Hospital Schleswig Holstein Lübeck Germany

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