TY - JOUR
T1 - Postoperative right ventricular failure after left ventricular assist device placement is predicted by preoperative echocardiographic structural, hemodynamic, and functional parameters
AU - Raina, Amresh
AU - Seetha Rammohan, Harish Raj
AU - Gertz, Zachary M.
AU - Rame, J. Eduardo
AU - Woo, Y. Joseph
AU - Kirkpatrick, James N.
N1 - Funding Information:
Dr Rame has been a primary investigator in clinical trials sponsored by Thoratec Corporation and Heartware. Dr Kirkpatrick has received a grant from the Greenwall Foundation to examine caregiver stress in LVAD recipients. The other authors report no potential conflicts of interest.
PY - 2013/1
Y1 - 2013/1
N2 - Background: Right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation results in significant morbidity and mortality. Preoperative parameters from transthoracic echocardiography (TTE) that predict RVF after LVAD implantation might identify patients in need of temporary or permanent right ventricular (RV) mechanical or inotropic support. Methods and Results: Records of all patients who had preoperative TTE before implantation of a permanent LVAD at our institution from 2008 to 2011 were screened, and 55 patients (age 54 ± 16 years, 71% male) were included: 26 had LVAD implantation alone with no postoperative RVF, 16 had LVAD implantation alone but experienced postoperative RVF, and 13 had initial biventricular assist devices (BIVADs). The LVAD with RVF and BIVAD groups (RVF group) were pooled for comparison with the LVAD patients without RVF (No RVF group). RV fractional area change (RV FAC) was significantly lower in the RVF group versus the No RVF group (24% vs 30%; P =.04). Tricuspid annular plane systolic excursion was not different among the groups (1.6 cm vs 1.5 cm; P =.53). Estimated right atrial pressure (RAP) was significantly higher in the RVF group versus the No RVF group (11 mm Hg vs 8 mm Hg; P =.04). Left atrial volume (LAV) index was lower in patients with RVF versus No RVF (27 mL/m2 vs 40 mL/m2; P =.008). Combining RV FAC, estimated RAP, and LAV index into an echocardiographic scoring system revealed that the TTE score was highly predictive of RVF (5.0 vs 2.8; P =.0001). In multivariate models combining the TTE score with clinical variables, the score was the most predictive of RVF (odds ratio 1.66, 95% confidence interval 1.06-2.62). Conclusions: Preoperative RV FAC, estimated RAP, and LAV index predict postoperative RVF in patients undergoing LVAD implantation. These parameters may be combined into a simple echocardiographic scoring system to provide an additional tool to risk-stratify patients being evaluated for LVAD implantation.
AB - Background: Right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation results in significant morbidity and mortality. Preoperative parameters from transthoracic echocardiography (TTE) that predict RVF after LVAD implantation might identify patients in need of temporary or permanent right ventricular (RV) mechanical or inotropic support. Methods and Results: Records of all patients who had preoperative TTE before implantation of a permanent LVAD at our institution from 2008 to 2011 were screened, and 55 patients (age 54 ± 16 years, 71% male) were included: 26 had LVAD implantation alone with no postoperative RVF, 16 had LVAD implantation alone but experienced postoperative RVF, and 13 had initial biventricular assist devices (BIVADs). The LVAD with RVF and BIVAD groups (RVF group) were pooled for comparison with the LVAD patients without RVF (No RVF group). RV fractional area change (RV FAC) was significantly lower in the RVF group versus the No RVF group (24% vs 30%; P =.04). Tricuspid annular plane systolic excursion was not different among the groups (1.6 cm vs 1.5 cm; P =.53). Estimated right atrial pressure (RAP) was significantly higher in the RVF group versus the No RVF group (11 mm Hg vs 8 mm Hg; P =.04). Left atrial volume (LAV) index was lower in patients with RVF versus No RVF (27 mL/m2 vs 40 mL/m2; P =.008). Combining RV FAC, estimated RAP, and LAV index into an echocardiographic scoring system revealed that the TTE score was highly predictive of RVF (5.0 vs 2.8; P =.0001). In multivariate models combining the TTE score with clinical variables, the score was the most predictive of RVF (odds ratio 1.66, 95% confidence interval 1.06-2.62). Conclusions: Preoperative RV FAC, estimated RAP, and LAV index predict postoperative RVF in patients undergoing LVAD implantation. These parameters may be combined into a simple echocardiographic scoring system to provide an additional tool to risk-stratify patients being evaluated for LVAD implantation.
KW - Right ventricular failure
KW - echocardiography
KW - risk prediction
KW - ventricular assist device
UR - http://www.scopus.com/inward/record.url?scp=84871900044&partnerID=8YFLogxK
U2 - 10.1016/j.cardfail.2012.11.001
DO - 10.1016/j.cardfail.2012.11.001
M3 - Article
C2 - 23273590
AN - SCOPUS:84871900044
SN - 1071-9164
VL - 19
SP - 16
EP - 24
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 1
ER -