Right ventricular pulmonary arterial coupling in patients with implanted left ventricular assist devices

Abstract

Abstract Background Both the right ventricular (RV) contractile function and pulmonary arterial (PA) pressure influence clinical outcomes in patients supported with left ventricular assist devices (LVADs), but the impact of RV-PA coupling is unknown. Purpose This study aimed to determine the prognostic impact of RV-PA coupling in patients with implanted LVADs. Methods Patients with implanted third-generation LVADs were retrospectively enrolled. The RV-PA coupling was assessed preoperatively by the ratio of RV free wall strain (RVFWS) and noninvasively measured peak RV systolic pressure (RVSP). The primary endpoint was a composite of all-cause mortality or right heart failure (RHF) hospitalization. Secondary endpoints consisted of all-cause mortality at a 12-month follow-up and RHF hospitalization. Results A total of 72 patients with good RV myocardial imaging were included. The median age was 57 years, 67 patients (93.1%) were men and 41 (56,9%) had dilated cardiomyopathy. A receiver-operating characteristic analysis (AUC 0.703, 51.5% sensitivity, 94.9% specificity) was used to identify the optimal cutoff point (0.28%/mmHg) for the RVFWS/TAPSE threshold. Event rates were estimated using the Kaplan-Meier method showing an association with an increased risk for the primary endpoint of death or RHF hospitalization (89.47% vs. 30.19%, p<0.001). A similar observation applied to all-cause mortality (47.37% vs. 13.21%, p=0.003) and RHF hospitalization (80.43% vs. 20%, p<0.001). Conclusion An advanced RV dysfunction assessed by RV-PA coupling may serve as a predictor of adverse outcomes in patients with implanted LVADs.