Abstract
Purpose Right ventricular failure (RVF) is associated with significant morbidity following left ventricular assist device (LVAD) surgery. Hemodynamic, clinical, and 2-dimensional echocardiographic variables poorly discriminate patients at risk of RVF. We examined the utility of 3-dimensional echocardiography (3DE) right ventricular (RV) volumetric assessment to identify patients at risk of RVF. Methods and Materials RVF was defined as need for inotropic infusion for >14 days following LVAD surgery or RV assist device (RVAD) placement. Preoperative RV volumes and ejection fraction (RVEF) were measured, blinded to clinical data, from transthoracic 3DE full volume data sets in 29 patients. Univariate analyses were used to compare baseline variables and 3DE RV indices among patients with and without RVF. Multivariate logistic regression was used to adjust for baseline covariates. Results 25 patients (86%) received continuous flow LVADs. 13 patients (45%) had RVF 2 required RVAD support and 11 required prolonged inotropes. Cardiac index (CI), RV stroke work index (RVSWI), indexed RV end diastolic and systolic volumes (RVEDVI & RVESVI) and RVEF were associated with RVF. RVEDVI (OR 1.082 (1.00, 1.17), p=0.049) and RVESVI (OR 1.117 (1.00, 1.25), p=0.049) remained associated with RVF after adjusting for RVSWI. Conclusions Quantitative 3DE is a promising method for pre-LVAD RV assessment. RV volumes assessed by 3DE are predictive of RVF in LVAD recipients, independent of RVSWI. Comparison of 3DE and baseline variables among patients with and without RVF. No RVF (mean±SD) RVF (mean±SD) P-value RVEDVI (ml/m2) 46 ± 13 65 ± 21 0.008 RVESVI (ml/m2) 30 ± 9 53 ± 22 0.0095 RVEF (%) 33 ± 9 23 ± 12 0.014 RVSWI (mmHg ml/m2) 644 ± 267 400 ± 175 0.0092 CI (l/min/m2) 2.3 ± 0.6 1.9 ± 0.3 0.047 Total Bilirubin (mg/dL) 1.4 ± 0.8 1.6 ± 0.9 0.68 BUN (mg/dL) 24 ± 13 17 ± 8 0.06 Right atrial pressure/PCWP ratio 0.4 ± 0.1 0.6 ± 0.2 0.09 Right atrial pressure (mmHg) 10 ± 4 14 ± 7 0.17
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