Prognostic value of hemodynamic indices prior to tMCS explantation: An analysis from the Cardiogenic Shock Working Group.

Publication Title

Journal of cardiac failure

Authors

• Christian Said
• Jaime Hernandez-Montfort
• Jonas Sundermeyer
• Song Li
• Rachna Kataria
• Elric Zweck
• Anthony Faugno
• Shashank S Sinha
• Jacob Abraham, Center for Cardiovascular Analytics, Research, & Data Science (CARDS), Providence St. Joseph Research Network, Portland, USA.Follow
• Manreet K Kanwar
• Arthur Reshad Garan
• Van-Khue Ton
• Claudius Mahr
• Paavni Sangal
• Peter Natov
• M Imran Aslam
• Daniel Burkhoff
• Navin K Kapur

Document Type

Article

Publication Date

3-2-2026

Keywords

cardiogenic shock; mechanical circulatory support; outcome; weaning.; oregon; portland; CARDS; PRN; cards publication

Abstract

BACKGROUND: Standardized hemodynamic-guided weaning criteria are needed for patients with cardiogenic shock receiving temporary mechanical circulatory support (tMCS). We aimed to determine whether hemodynamic indices prior to tMCS explant predict mortality and native heart survival and whether performance varies across device platforms.

METHODS: We analyzed 385 cardiogenic shock patients from the multicenter Cardiogenic Shock Working Group registry who received tMCS. Four indices were evaluated: blood pressure response index (BPRI), organ perfusion pressure (OPP), aortic pulsatility index (API), and modified API (mAPI). The primary outcome was in-hospital mortality and secondary outcome was native heart survival. Multivariable models adjusted for age, sex, and device type. Receiver operating characteristic (ROC) curves assessed discrimination, restricted cubic splines examined non-linear relationships, and device-stratified analyses evaluated platform-specific performance.

RESULTS: BPRI demonstrated the highest area under the curve (AUC) for mortality (AUC 0.786) and native heart survival (AUC 0.747) compared with OPP (0.711), mAPI (0.654), and API (0.600). Survivors demonstrated BPRI improvement (8.4 to 18.2) while non-survivors showed stagnation (4.7 to 5.2). Each 10-point BPRI increase was associated with 46% mortality reduction (OR 0.54, 95% CI 0.42-0.68, P< 0.001). BPRI remained strongly associated with lower mortality across device platforms, including Impella (OR 0.24, 95% CI 0.10-0.58, P=0.001) and IABP (OR 0.65, 95% CI 0.48-0.90, P=0.008).

CONCLUSION: Pre-explant BPRI demonstrated the highest prognostic accuracy for mortality and native heart survival across multiple tMCS platforms.

Area of Special Interest

Cardiovascular (Heart)

Specialty/Research Institute

Cardiology

DOI

10.1016/j.cardfail.2026.02.019