Abstract
Right ventricular failure (RVF) after left ventricular assist device (LVAD) implant is associated with increasing morbidity and mortality. The aim of this study was to identify the best predictors of RVF post LVAD-implant among biochemical, haemodynamic and echocardiographic parameters. From 2009 to 2019, 38 patients who underwent LVAD implantation at our centre were prospectively enrolled. Preoperative clinical, laboratory, echocardiographic and haemodynamic parameters were reported. Overall, eight patients (21%) developed RVF over time, which revealed to be strongly related to overall mortality. Pulmonary artery pulsatility index (PAPi) resulted to be the most significant right heart catheterization index in discriminating RVF vs no RVF patients [(1.32 ± 0.26 vs. 3.95 ± 3.39 respectively) p = 0.0036]. Regarding transthoracic echocardiography, RVF was associated with reduced free wall right ventricular longitudinal strain (fw-RVLS) (− 7.9 ± 1.29 vs. − 16.14 ± 5.83) (p < 0.009), which was superior to other echocardiographic determinants of RVF. Among laboratory values, N-terminal pro-brain natriuretic peptide (NT-proBNP) was strongly increased in RVF patients [(10,496.13 pg/ml ± 5272.96 pg/ml vs. 2865, 5 pg/ml ± 2595.61 pg/ml) p = 0.006]. PAPi, NT-proBNP and fwRVLS were the best pre-operative predictors of RVF, a post-LVAD implant complication which was confirmed to have a great impact on survival. In particular, fwRVLS has been proven to be the strongest independent predictor.
Highlights
Over the last decades there has been a progressive technological development of long-term durable mechanical circulatory support in response to a growing population withM
Various attempts to stratify Right ventricular failure (RVF) risk have been proposed, including: clinical parameters such as the requirement for inotropic support, or the interagency registry for mechanically assisted circulatory support (INTERMACS) classification; invasive haemodynamic parameters obtained through right heart catheterization such as increased pulmonary vascular resistance, pulmonary capillary wedge pressure (PCWP) to central venous pressure (CVP) ratio, echocardiographic indices of RV function [7] and markers of end-organ dysfunction, such as blood-urea nitrogen levels [8]
In RVF group we found pre-operative lower tricuspid annular plane systolic excursion (TAPSE) (RVF 11.88 ± 2.90 mm vs. no-RVF 16.52 ± 4.40 mm p = 0.02 OR 0.71), lower RV fractional area change (RVFAC) (RVF 34.63 ± 9.98% vs. no-RVF 40.59 ± 5.15% p = 0.04 OR 0.87), reduced free wall right ventricular longitudinal strain (fw-RVLS) (− 7.9 ± 1.29% vs. − 15.99 ± 5.15 p < 0.009) (Fig. 2; Table 2)
Summary
The International Journal of Cardiovascular Imaging when defining the eligibility for LVAD implantation and the best peri-operative management. Various attempts to stratify RVF risk have been proposed, including: clinical parameters such as the requirement for inotropic support, or the interagency registry for mechanically assisted circulatory support (INTERMACS) classification; invasive haemodynamic parameters obtained through right heart catheterization such as increased pulmonary vascular resistance, pulmonary capillary wedge pressure (PCWP) to central venous pressure (CVP) ratio, echocardiographic indices of RV function [7] and markers of end-organ dysfunction, such as blood-urea nitrogen levels [8]. Our study aimed firstly to define the best pre-operative predictors, among clinical, laboratory, echocardiographic and invasive haemodynamic parameters, of post-LVAD RVF, and secondary to assess the impact of RVF on survival
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
