Abstract
<h3>Purpose</h3> Right Heart failure (RHF) is a severe complication after left ventricular assist device (LVAD) implantation, increasing early and late mortality. Although numerous RHF predictive models have been developed, there are few independent comparative analyses of these risk models.We aimed to compare the existent risk scores models and to identify the best predictors of severe RHF at our center. <h3>Methods</h3> Early severe RHF was defined as use of inotropes for ≥14 days, nitric oxide use for ≥48 hours or unplanned right-sided circulatory support. A logistic regression model was fitted right ventricular failure from individual variables selected by a likelihood ratio chi-square test or by fitting a univariate logistic regression model to obtain a likelihood ratio test. All variables with a p-value < 0.25 were included to fit an initial full logistic regression model.Risk models (Michigan, EUROMACS, CRITT) were evaluated for the primary outcome of RHF or RVAD implantation by means of logistic regression and receiver operating characteristic curves from their respective scores in our population. <h3>Results</h3> Among 92 LVAD patients retrospectively reviewed from 2011 to 2020, 24 (26%) developed early severe RHF.In the comparative analysis of the 3 predictive scores, the EUROMACS-RHF risk score performed the best in predicting RHF (C=0.82 - 95% CI: 0.68-0.90).Our new model was based on four variables, selected for the best reduced logistic model: the INTERMACS scale, the number of inotropes, ratio of right atrial/pulmonary capillary wedge pressure (RAP/PWCP) and ratio of right ventricle/left ventricle (RV/LV) diameters. This model demonstrated significant discrimination of RHF (C=0.91 - 95% CI: 0.76-0.96). <h3>Conclusion</h3> Amongst the available risk scores, the EUROMACS performs best to predict the occurrence of RHF after LVAD implantation. Based on 4 simple metrics, our model's performance compares well to the EUROMACS score.
Highlights
Right Heart Failure (RHF) is a severe complication that can occur after left ventricular assist device (LVAD) implantation, increasing early and late mortality
The EUROMACS-RHF risk score performed the best in predicting RHF (C=0.82 - 95% CI: 0.68-0.90), compared with the other scores (Michigan, CRITT)
EUROMACS-RHF performs best to predict the occurrence of RHF after LVAD implantation
Summary
Implantable left ventricular assist devices (LVADs) represent an available and effective alternative to HT, allowing a decrease in morbidity and mortality observed in advanced HF, in patients on HT waiting lists [6,7]. Post-LVAD acute RHF is common and prevalence has been reported between 4% and 50% 10–15. It is characterized by the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) as documented elevations of central venous pressure associated with more than one clinical or biological manifestations. Right Heart Failure (RHF) is a severe complication that can occur after left ventricular assist device (LVAD) implantation, increasing early and late mortality. Numerous RHF predictive scores have been developed, limited data exist on the external validation of these models.
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