Association between left ventricular ejection fraction, mortality and use of mechanical circulatory support in patients with non-ischaemic cardiogenic shock

Research output: Contribution to journalResearch articleContributedpeer-review


  • Jonas Sundermeyer - , University Hospital Hamburg Eppendorf (Author)
  • Caroline Kellner - , University Hospital Hamburg Eppendorf (Author)
  • Benedikt N Beer - , University Hospital Hamburg Eppendorf (Author)
  • Lisa Besch - , University Hospital Hamburg Eppendorf (Author)
  • Angela Dettling - , University Hospital Hamburg Eppendorf (Author)
  • Letizia Fausta Bertoldi - , Cardio Center (Author)
  • Stefan Blankenberg - , University Hospital Hamburg Eppendorf (Author)
  • Jeroen Dauw - , DRK Kliniken Berlin Köpenick (Author)
  • Zouhir Dindane - , Heart Center Dresden University Hospital (Author)
  • Dennis Eckner - , Paracelsus Medical University Nuremberg (Author)
  • Ingo Eitel - , Deutsches Zentrum für Herz-Kreislaufforschung (DZHK) (Author)
  • Tobias Graf - , Deutsches Zentrum für Herz-Kreislaufforschung (DZHK) (Author)
  • Patrick Horn - , University Hospital Duesseldorf (Author)
  • Joanna Jozwiak-Nozdrzykowska - , Heart Center Leipzig (Author)
  • Paulus Kirchhof - , University Hospital Hamburg Eppendorf (Author)
  • Stefan Kluge - , University Hospital Hamburg Eppendorf (Author)
  • Axel Linke - , Department of internal Medicine with focus on Cardiology (at Herzzentrum Dresden) (Author)
  • Ulf Landmesser - , DRK Kliniken Berlin Köpenick (Author)
  • Peter Luedike - , University Hospital Essen (Author)
  • Enzo Lüsebrink - , University Hospital Olomouc (Author)
  • Nicolas Majunke - , Heart Center Leipzig (Author)
  • Norman Mangner - , Department of internal Medicine with focus on Cardiology (at Herzzentrum Dresden), TUD Dresden University of Technology (Author)
  • Octavian Maniuc - , University Hospital of Würzburg (Author)
  • Sven Möbius Winkler - , Jena University Hospital (Author)
  • Peter Nordbeck - , University Hospital of Würzburg (Author)
  • Martin Orban - , University Hospital Olomouc (Author)
  • Federico Pappalardo - , Dept Cardiothoracic and Vascular Anesthesia and Intensive Care (Author)
  • Matthias Pauschinger - , Paracelsus Medical University Nuremberg (Author)
  • Michal Pazdernik - , DRK Kliniken Berlin Köpenick (Author)
  • Alastair Proudfoot - , Barts Health NHS Trust (Author)
  • Matthew Kelham - , Barts Health NHS Trust (Author)
  • Tienush Rassaf - , University Hospital Essen (Author)
  • Clemens Scherer - , University Hospital Olomouc (Author)
  • Paul Christian Schulze - , Jena University Hospital (Author)
  • Robert H G Schwinger - , Medizinische Klinik II/Rheumatologie (Author)
  • Carsten Skurk - , DRK Kliniken Berlin Köpenick (Author)
  • Marek Sramko - , DRK Kliniken Berlin Köpenick (Author)
  • Guido Tavazzi - , IRCCS S. Maria Nascente-Fondazione Don Carlo Gnocchi Onlus (Author)
  • Holger Thiele - , Heart Center Leipzig (Author)
  • Luca Villanova - , Unità Di Cure Intensive Cardiologiche and De Gasperis Cardio-Center (Author)
  • Nuccia Morici - , IRCCS S. Maria Nascente-Fondazione Don Carlo Gnocchi Onlus (Author)
  • Ralf Westenfeld - , University Hospital Duesseldorf (Author)
  • Ephraim B Winzer - , Heart Center Dresden University Hospital (Author)
  • Dirk Westermann - , University Medical Center Freiburg (Author)
  • Benedikt Schrage - , University Hospital Hamburg Eppendorf (Author)


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. Impact of left ventricular ejection fraction on mortality and use of mechanical circulatory support in non-ischaemic cardiogenic shock. Hazard ratio for 30-day mortality across the LVEF continuum, adjusted for age, sex, SCAI shock stage, worst value of lactate and pH within 6 h, prior resuscitation and mechanical ventilation during the index shock event. LVEF: Left ventricular ejection fraction; MCS: Mechanical circulatory support; HR: Hazard ratio; CI: Confidence interval.


Original languageEnglish
JournalClinical Research in Cardiology
Publication statusE-pub ahead of print - 20 Nov 2023

External IDs

Scopus 85177055570