Abstract
Purpose The EUROMACS Right-Sided Heart Failure Risk Score was developed to predict right ventricular failure (RVF) after left ventricular assist device (LVAD) placement. The performance of this model outside the derivation cohort has not been tested. Methods EUROMACS Right-Sided Heart Failure Risk Scores were calculated and assessed as predictors of post-operative RVF in a single center continuous flow (CF) LVAD cohort (n=451). Only patients with complete data for risk score calculation and RVF determination were included in the analysis (n = 254). RVF was defined as RVAD within 30 days, continuous inotropic support ≥ 14 days, or inhaled pulmonary vasodilatory use for > 48 hours after LVAD implantation. Results Thirty-nine percent of patients (100/254) had post-operative RVF, however only 9% (23/254) required prolonged inotropic support and 5% (12/254) required RVAD placement. Development of RVF after LVAD was associated with a 45% increase the hazards rate of death on LVAD support (HR 1.45, 95 % CI 0.98-2.2, p =0.066), however this was not statistically significant. The increase in mortality associated with RVF was largely driven by patients who required RVAD support (HR 4.6, 95 % CI 2.3- 9.1, p Conclusion The EUROMACS Right-Sided Heart Failure Risk Score had poor discrimination in this LVAD dataset. These findings further emphasize the difficulty of predicting RVF after LVAD placement. Further work is required to enhance our understanding pre- LVAD right ventricular physiology and to accurately risk stratify patients.
Highlights
Right ventricular (RV) failure remains common after left ventricular assist device placement (LVAD) even in contemporary continuous flow era 1, and remains a leading cause of morbidity and mortality after LVAD placement [2,3]
The following demographic and clinical covariate data are available in the University of Minnesota LVAD database, which is updated through data extraction and manual chart review: age, gender, body mass index (BMI), serum creatinine, albumin, Interagency Registry for Mechanical Circulatory Support (INTERMACS) profile, pre-operative hemodynamics, bridge to transplant status, cardiomyopathy type, presence of diabetes, and NT pro b-type natriuretic peptide (NT-proBNP)
We found that right ventricular failure was associated with mortality after CF-LVAD
Summary
Right ventricular (RV) failure remains common after left ventricular assist device placement (LVAD) even in contemporary continuous flow era 1, and remains a leading cause of morbidity and mortality after LVAD placement [2,3]. One of the more recently published risk models was developed from the EUROMACS database 7 This analysis included 2,988 patients implanted with LVADs in Europe in which 433 patients (21.7%) developed right ventricular failure. A combination of five variables were found to be highly predictive of right sided heart failure. These variables include right atrial/pulmonary capillary wedge pressure > 0.54, hemoglobin < 10 g/dL, use of multiple intravenous inotropes prior to LVAD implantation, INTERMACS Class [1,2,3], and severe right ventricular dysfunction on echocardiography. The purpose of this study was to assess the performance of the EUROMACs score in a large, external continuous flow LVAD dataset and assess for other univariate predictors of RV failure
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