Does Hemodynamic Response to Inotropes Predict Early Right Heart Failure After LVAD Implantation?

Abstract

<h3>Purpose</h3> Right ventricular (RV) failure is a highly morbid clinical condition following left ventricular assist device (LVAD) implantation. We aimed to compare baseline and post-inotrope(s) hemodynamics as predictors of early right heart failure (RHF) after LVAD implantation. <h3>Methods</h3> We performed a single-center, retrospective analysis of all patients implanted with an LVAD between January 2018 and September 2020. We included patients with pre-implant baseline hemodynamics without augmentation by inotropic or mechanical circulatory support (MCS). This cohort was then placed on inotrope(s) with documented hemodynamics at 24 hours. We then utilized the Academic Research Consortium early RHF criteria to define severe-acute RHF (requirement of assist device or high dose inotropes with end-organ dysfunction). Stroke volume index (SVI) was identified as a surrogate of RV inotropic reserve. Comparisons between patients with and without early RHF were made using Fisher's Exact and Chi-Square tests, with probabilities determined by a binary logistical regression model. <h3>Results</h3> A total of 48 patients met study inclusion criteria. Early post-implant RHF was noted in 45.8% (n=22) of this population. There were no statistical differences among these groups when evaluated for type of inotrope utilized (p=0.2126), change in cardiac index (p=0.8924), or change in SVI (p=0.5659). There was, however, a nonsignificant trend towards decreased probability of development of early RHF, as evidenced by percent improvement in post-inotrope(s) SVI. This was most apparent in patients who received milrinone monotherapy (Figure). <h3>Conclusion</h3> We observed a nonsignificant trend of improved RV inotropic reserve represented by improvement in post-inotrope SVI, which numerically correlated with less early RHF.