Early bedside echocardiographic assessment of left ventricular fractional shortening for predicting neurological outcome after in-hospital cardiac arrest: A retrospective cohort study

Background: In-hospital cardiac arrest (IHCA) is associated with poor neurological recovery, partly driven by post-cardiac arrest syndrome (PCAS) involving myocardial dysfunction. Objectives: We investigated the prognostic value of early post-resuscitation left ventricular fractional shortening (LVFS) for neurological outcome and its incremental predictive value beyond established clinical risk scores. Methods: This retrospective cohort study analyzed IHCA patients who achieved ROSC at Zigong Fourth People's Hospital between January 2019 and December 2024. Neurological outcome at discharge was defined by cerebral performance category (CPC) score ≤ 2. Candidate variables were Nassessed using multivariable logistic regression, with nonlinear relationships examined through restricted cubic spline analysis. Model discrimination and improvement were assessed by receiver operating characteristic (ROC) analysis, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA). Predefined subgroup analyses were also performed. Results: Among 173 patients, 29 (16.7%) achieved favorable outcomes. Left ventricular fractional shortening (LVFS) was an independent predictor of good neurological recovery (OR 1.154, 95% CI 1.056–1.262, p = 0.002), showing a linear relationship (p for nonlinearity = 0.521). The optimal LVFS cutoff was 29.5% (AUC 0.714). Combined models demonstrated progressive improvement in prediction: LVFS + CASPRI or LVFS + MEWS increased discrimination, and triple integration (LVFS + CASPRI + MEWS) achieved excellent accuracy (AUC 0.904). NRI and IDI of triple integration confirmed reclassification gains (p < 0.05), while DCA showed the highest net clinical benefit. A potential interaction between age and LVFS regarding neurological outcome was observed (p = 0.037). Conclusion: LVFS assessed after ROSC independently predicts neurological outcome in IHCA and provides significant incremental predictive value beyond CASPRI and MEWS.