Prediction of Right Heart Failure after Left Ventricular Assist Implantation: External Validation of the EUROMACS Right-Sided Heart Failure Risk Score

Abstract

<h3>Purpose</h3> Prediction of right heart failure (RHF) after left ventricular assist device (LVAD) implant is a crucial step to improve outcomes. The EUROMACS Right-Sided Heart Failure (EUROMACS-RHF) risk score is one of the most recent derived scores for RHF prediction after LVAD but it lacks external validation. The aim of our study was to validate the EUROMACS-RHF risk score. <h3>Methods</h3> From 01/2007 to 12/2017, 878 continuous-flow LVADs were implanted at three tertiary care centers. We calculated the EUROMACS-RHF score in 662 patients with complete data. We evaluated the predictive performance of the score for early RHF defined as need for short- or long-term right-sided circulatory support, continuous inotropic support for ≥14 days or nitric oxide ventilation for ≥48 hours post-operatively. <h3>Results</h3> RHF occurred in 211 patients (32%). RHF patients had higher creatinine, bilirubin and right atrial pressure, more echocardiographic RV dysfunction and were more critically ill reflected in lower INTERMACS class (p<0.05). Length of stay and in-hospital mortality were higher in patients with RHF. Area under the ROC curve for RHF prediction of the EUROMACS-RHF score was 0.64 (95% CI 0.60-0.68), and slightly higher for the right ventricular assist device implantation component RHF definition [0.67 (95% CI 0.61-0.74)]. Risk discrimination of the score was significantly better than for other three previous published scores and reclassification of patient risk improved when the EUROMACS-RHF score was applied. Patients in the high-risk category according to the EUROMACS-RHF score had also significantly higher in-hospital and 2-year all-cause mortality. <h3>Conclusion</h3> In an external validation, the EUROMACS-RHF had similar discrimination predicting RHF compared to the original derivation cohort, which was better than other published scores. The clinical utility of these scores in the decision to implant LVAD in prospective studies remains to be determined.