Invasive Hemodynamic after LVAD Implantation and Association with Outcomes

Abstract

Background There is paucity of data on assessment of invasive hemodynamics via right heart catheterization (RHC) after LVAD implantation and association with outcomes. We sought out to define if right ventricular (RV) dysfunction, persistent volume overload and low cardiac output state defined via invasive hemodynamics is associated with adverse 1-year outcomes. Methods We conducted a retrospective analysis of end-stage heart failure (HF) patients who underwent continuous-flow LVAD implantation and subsequent right heart catheterization (RHC) to determine invasive hemodynamics. 1-year outcomes including mortality, all-cause readmission and HF readmissions were assessed after index RHC. Definitions included low cardiac output state (CI) 12 mm Hg), moderate right ventricle (RV) dysfunction (RAP/pulmonary capillary wedge pressure (PCWP) >0.75) and severe right ventricle dysfunction (RA/PCWP >1). Chi-square for categorical variables and Student's T-test for continuous variables were used to determine significant differences in each group. Results A total of 142 patients underwent invasive hemodynamics after LVAD implantation. The median time from LVAD implantation to RHC was 6 months. RAP/PCWP ratio was not predictive of adverse outcome and although RAP > 12 mmHg was not associated with increased mortality it was associated with significantly increased HF readmissions at 1 year. Discussion RV dysfunction defined using invasive hemodynamic criteria did not predict adverse 1-year outcomes. RAP > 12 mmHg indicative of persistent volume overload after LVAD implantation was significantly associated with increase HF readmissions at 1 year.