The Role of Right Ventricular Strain in Women and Men Following Left Ventricular Assist Device Implantation

Abstract

BackgroundWomen and men have different perioperative hemodynamics, adverse event rates, and pump thrombosis-related mortality following left ventricular assist device (LVAD) implantation. However, gender differences in the subsequent development of right ventricular (RV) failure are not well defined. We evaluated the impact of gender on RV failure following LVAD implantation by speckle-tracking analysis of pre- and postoperative echocardiograms (echo).MethodsPre- and post-operative clinical, echo, and hemodynamic parameters were recorded in patients receiving LVADs from 2008-2018. Retrospectively, a subgroup of 74 women and 74 men were propensity score-matched 1:1 and chi square, t-tests, nonparametric tests, regression analysis, and Kaplan-Meier analysis were used to compare event rates. RV free-wall longitudinal strain (RV-FLS) and RV Fractional Area Change (RV-FAC) were calculated retrospectively using speckle-tracking, Tomtec Arena. All echo and RV strain measurements were blinded to gender outcomes.ResultsPreoperative hemodynamic parameters were not different between the two groups. However, women were more likely to have non-ischemic cardiomyopathy (81% vs 65%; p<0.001) and higher CHADS2VASC scores (3.0 vs 2.5; p<0.001), while men were more likely to have ischemic cardiomyopathy (35% vs 19%; p<0.026). Postoperative ICU stays were longer for women than men (149 vs 98 hours, respectively; p<0.016), as was the need for prolonged ventilation (61% vs 41%, respectively; p=0.014) and blood products (77% vs 62%, respectively; p=0.049). All echo parameters are presented in the table. The delta between pre and post-op RV free wall strain was not significant. Two year survival was 66.4% for the female group and 70.2% for the male group and 5-year survival was 55.3% for males and 63.6% for females (Fig 1).ConclusionsRV strain analysis tracks standard hemodynamic and echo parameters and does not add to the assessment of RV function in women and men undergoing LVAD implantation. Women and men have different perioperative hemodynamics, adverse event rates, and pump thrombosis-related mortality following left ventricular assist device (LVAD) implantation. However, gender differences in the subsequent development of right ventricular (RV) failure are not well defined. We evaluated the impact of gender on RV failure following LVAD implantation by speckle-tracking analysis of pre- and postoperative echocardiograms (echo). Pre- and post-operative clinical, echo, and hemodynamic parameters were recorded in patients receiving LVADs from 2008-2018. Retrospectively, a subgroup of 74 women and 74 men were propensity score-matched 1:1 and chi square, t-tests, nonparametric tests, regression analysis, and Kaplan-Meier analysis were used to compare event rates. RV free-wall longitudinal strain (RV-FLS) and RV Fractional Area Change (RV-FAC) were calculated retrospectively using speckle-tracking, Tomtec Arena. All echo and RV strain measurements were blinded to gender outcomes. Preoperative hemodynamic parameters were not different between the two groups. However, women were more likely to have non-ischemic cardiomyopathy (81% vs 65%; p<0.001) and higher CHADS2VASC scores (3.0 vs 2.5; p<0.001), while men were more likely to have ischemic cardiomyopathy (35% vs 19%; p<0.026). Postoperative ICU stays were longer for women than men (149 vs 98 hours, respectively; p<0.016), as was the need for prolonged ventilation (61% vs 41%, respectively; p=0.014) and blood products (77% vs 62%, respectively; p=0.049). All echo parameters are presented in the table. The delta between pre and post-op RV free wall strain was not significant. Two year survival was 66.4% for the female group and 70.2% for the male group and 5-year survival was 55.3% for males and 63.6% for females (Fig 1). RV strain analysis tracks standard hemodynamic and echo parameters and does not add to the assessment of RV function in women and men undergoing LVAD implantation.