Predictors of late right heart failure after mechanical circulatory support

Abstract

Abstract Introduction Right heart failure (RHF) is associated with a worse outcome in mechanical circulatory support (MCS). Several studies have identified risk factors for RHF shortly after MCS, though information about late RHF is limited. Purpose We aimed to identify risk factors for late RHF in patients with MCS, implanted as a bridge to heart transplantation. Methods Data of all patients, who were successfully discharged after MCS implantation in a University Medical Center between 2006–2019 were included and follow-up was completed until March 2019. Late RHF was defined as the occurrence of right ventricular dysfunction associated with symptoms, including jugular venous distension, hepatic congestion and peripheral edema during MCS support, if diagnosed after the index admission for MCS implantation. The primary end point was the diagnosis of late RHF in combination with the need for intensification of diuretics (either with or without hospitalization) and/or the need for inotropes and/or right ventricular assist device. Univariable and multivariable Cox regression analyses were performed to identify risk factors for late RHF. Results 262 patients (66% male, mean age 51±13 years) had a mean follow-up of 901±643 days. 49 (18.7%) patients suffered from late RHF after a median of 363 (IQR 131–1001) days. Multivariable risk factors for late RHF were a higher body mass index (hazard ratio (HR) 1.05; CI 1.00–1.11), a history of atrial fibrillation (AF) prior to the operation (HR 2.11; CI 1.12–3.96), a lower (i.e. clinically worse) INTERMACS profile and a longer duration on the intensive care unit (HR 1.03; CI 1.00–1.06) during the index admission for MCS implantation (Table 1). The occurrence of early RHF was not associated with late RHF (p=0.211). Conclusion Late RHF is a clinically important adverse event in MCS, affecting approximately 20% of patients. Risk factors associated with late RHF most relate to the severity of the clinical situation at the time of implantation. Funding Acknowledgement Type of funding source: None