Marie Aymami1, Myriam Amsallem2, Jackson Adams3, Karim Sallam3, Kegan Moneghetti4, Matthew Wheeler3, William Hiesinger5, Jeffrey Teuteberg3, Dana Weisshaar6, Jean-Philippe Verhoye3, Y Joseph Woo5, Richard Ha7, François Haddad3, Dipanjan Banerjee3. 1. Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Palo Alto, California; Division of Cardiac, Thoracic and Vascular Surgery, University Hospital of Rennes, Rennes, France. 2. Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Palo Alto, California; Research and Innovation Unit, INSERM U999, DHU Torino, Paris Sud University, Marie Lannelongue Hospital, Le Plessis Robinson, France. Electronic address: mamsalle@stanford.edu. 3. Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Palo Alto, California. 4. Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Palo Alto, California; Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia. 5. Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California. 6. Kaiser Permanente Northern California Advanced Heart Failure Program, Santa Clara, California. 7. Division of Cardiothoracic Surgery, Kaiser Permanente, California.
Abstract
BACKGROUND: Right heart failure (RHF) after left ventricular assist device (LVAD) implantation is associated with high morbidity and mortality. Existing risk scores include semiquantitative evaluation of right ventricular (RV) dysfunction. This study aimed to determine whether quantitative evaluation of both RV size and function improve risk stratification for RHF after LVAD implantation beyond validated scores. METHODS AND RESULTS: From 2009 to 2015, 158 patients who underwent implantation of continuous-flow devices who had complete echocardiographic and hemodynamic data were included. Quantitative RV parameters included RV end-diastolic (RVEDAI) and end-systolic area index, RV free-wall longitudinal strain (RVLS), fractional area change, tricuspid annular plane systolic excursion, and right atrial area and pressure. Independent correlates of early RHF (<30 days) were determined with the use of logistic regression analysis. Mean age was 56 ± 13 years, with 79% male; 49% had INTERMACS profiles ≤2. RHF occurred in 60 patients (38%), with 20 (13%) requiring right ventricular assist device. On multivariate analysis, INTERMACS profiles (adjusted odds ratio 2.38 [95% confidence interval [CI] 1.47-3.85]), RVEDAI (1.61 [1.08-2.32]), and RVLS (2.72 [1.65-4.51]) were independent correlates of RHF (all P < .05). Both RVLS and RVEDAI were incremental to validated risk scores (including the EUROMACS score) for early RHF after LVAD (all P < .01). CONCLUSIONS: RV end-diastolic and strain are complementary prognostic markers of RHF after LVAD implantation.
BACKGROUND: Right heart failure (RHF) after left ventricular assist device (LVAD) implantation is associated with high morbidity and mortality. Existing risk scores include semiquantitative evaluation of right ventricular (RV) dysfunction. This study aimed to determine whether quantitative evaluation of both RV size and function improve risk stratification for RHF after LVAD implantation beyond validated scores. METHODS AND RESULTS: From 2009 to 2015, 158 patients who underwent implantation of continuous-flow devices who had complete echocardiographic and hemodynamic data were included. Quantitative RV parameters included RV end-diastolic (RVEDAI) and end-systolic area index, RV free-wall longitudinal strain (RVLS), fractional area change, tricuspid annular plane systolic excursion, and right atrial area and pressure. Independent correlates of early RHF (<30 days) were determined with the use of logistic regression analysis. Mean age was 56 ± 13 years, with 79% male; 49% had INTERMACS profiles ≤2. RHF occurred in 60 patients (38%), with 20 (13%) requiring right ventricular assist device. On multivariate analysis, INTERMACS profiles (adjusted odds ratio 2.38 [95% confidence interval [CI] 1.47-3.85]), RVEDAI (1.61 [1.08-2.32]), and RVLS (2.72 [1.65-4.51]) were independent correlates of RHF (all P < .05). Both RVLS and RVEDAI were incremental to validated risk scores (including the EUROMACS score) for early RHF after LVAD (all P < .01). CONCLUSIONS: RV end-diastolic and strain are complementary prognostic markers of RHF after LVAD implantation.
Authors: Maria Concetta Pastore; Giuseppe De Carli; Giulia Elena Mandoli; Flavio D'Ascenzi; Marta Focardi; Francesco Contorni; Sergio Mondillo; Matteo Cameli Journal: Heart Fail Rev Date: 2021-11 Impact factor: 4.214