Latent class analysis (LCA) of transthoracic echocardiography (TTE) parameters identified four cardiovascular subphenotypes in acute respiratory distress syndrome (ARDS) that more closely aligned with circulatory failure mechanisms and mortality than current RVD definitions.

Latent class analysis (LCA) of TTE/hemodynamic parameters was performed in 801 patients, 62 years old (interquartile range, 50–72 yr old), 63% male, and 40% 90-day mortality rate.

Four cardiovascular subphenotypes were identified: class 1 (43%; mostly normal left and right ventricular [LV/RV] function), class 2 (24%; mostly dilated RV with preserved systolic function), class 3 (13%, mostly dilated RV with impaired systolic function), and class 4 (21%; mostly high cardiac output, with hyperdynamic LV function).

The four subphenotypes differed in their characteristics and outcomes, with 90-day mortality rates of 19%, 40%, 78%, and 59% in classes 1–4, respectively (p < 0.0001). Following multivariable logistic regression analysis, class 3 had the highest odds ratio (OR) for mortality (OR, 6.9; 95% CI, 4.0–11.8) compared with other RVD definitions.

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