The Incremental Value of Right Ventricular Size and Strain in the Risk Assessment of Right Heart Failure Post - Left Ventricular Assist Device Implantation

Marie Aymami, Myriam Amsallem, Jackson Adams, Karim Sallam, Kegan Moneghetti, Matthew Wheeler, William Hiesinger, Jeffrey Teuteberg, Dana Weisshaar, Jean Philippe Verhoye, Y. Joseph Woo, Richard Ha, François Haddad, Dipanjan Banerjee

Research output: Contribution to journalArticlepeer-review

26 Scopus citations

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.

Original languageEnglish
Pages (from-to)823-832
Number of pages10
JournalJournal of Cardiac Failure
Volume24
Issue number12
DOIs
StatePublished - Dec 2018
Externally publishedYes

Keywords

  • Echocardiography
  • Imaging
  • Left Ventricular Assist Device
  • Outcomes
  • Right Ventricle

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