Validation of the EUROMACS right-sided heart failure risk score in left ventricular assist device patients: a single center experience

Abstract

Abstract Background Right Heart failure (RHF) is a severe complication after left ventricular assist device (LVAD) implantation, increasing early and late mortality. A simple 5-item score, the EUROMACS-RHF risk score, was developed to predict early RHF and mortality after implantation. Purpose The aim of the study was to investigate whether EUROMACS-RHF risk score was applicable in a single center to predict early (<30 days) post-operative RHF. Methods From February 2011 to October 2019 all LVAD implanted patients in our institution were retrospectively reviewed. Only patients with complete data for risk score calculation and RHF analysis were included. Baseline characteristics and hospitalization data, including preoperative clinical, biological, echocardiographic and hemodynamic data were obtained. Based on these informations, EUROMACS-RHF risk score was calculated and classified in low, intermediate and high. The link between the EUROMACS-RHF risk score and early severe RHF was investigated using Pearson's exact chi-square tests. Results The analysis included 88 patients (67 males; 49±2 years). Etiology of HF was ischemic in 36 patients (41%), dilated cardiomyopathy in 21 (24%) and others causes in 31 (35%). A Heart Ware LVAD (94%) was implanted as bridge to transplantation in 96% of the patients; 81 patients (90%) had severe INTERMACS (1–3) profile. RHF was identified in 21 patients (24.1%), of which 15 (18%) were treated with inotropes for ≥14 days, 8 (9%) had an RVAD, and 11 (13%) were treated with inhaled NO for ≥48 hours. Patients with severe RHF had a significantly longer length of ICU stay compared to patients without (median 20 days versus 6,5 days). The early (<30 days) post-operatory mortality was of 43% (n=9/21) in the RHF group and 6% (n=4/69) in patients without RHF (p<0.001). Three of the twelve patients alive in the RHF group had an emergency transplant. The prediction of RHF from the EUROMACS-RHF risk score and the observed severe RHF are presented in the table. A high preoperative EUROMACS-RHF score was able to predict the presence of RHF in 52% of patients (p=0.005), while a low score predicted the absence of RHF in 52% of patients (p<0.001). In contrast, an intermediate EUROMACS risk score was not found to predict early RHF (p=0.283). Conclusion In our cohort, the EUROMACS-RHF risk score was effective in predicting early severe RHF, in particular for patients with preoperatory low (no RHF) and high (RHF) scores. This external validation confirms the clinical usefulness in risk prediction before LVAD implantation. Figure 1 Funding Acknowledgement Type of funding source: None