Background
The incremental utility of right ventricular (RV) strain on predicting right ventricular
failure (RVF) following left ventricular assist device (LVAD) implantation, beyond
clinical and haemodynamic indices, is not clear.
Methods
Two hundred and forty-six (246) patients undergoing LVAD implantation, who had transthoracic
echocardiograms pre and post LVAD, pulmonary artery pulsatility index (PAPI) measurements
and Michigan risk score, were included. We analysed RV global longitudinal strain
(GLS) using speckle tracking echocardiography. RVF following LVAD implantation was
defined as the need for medical support for >14 days, or unplanned RV assist device
insertion after LVAD implantation.
Results
Mean preoperative RV-GLS was -7.8±2.8%. Among all, 27% developed postoperative RVF.
A classification and regression tree analysis identified preoperative Michigan risk
score, PAPI and RV-GLS as important parameters in predicting postoperative RVF. Eighty
per cent (80%) of patients with PAPI <2.1 developed postoperative RVF, while only
4% of patients with PAPI >6.8 developed RVF. For patients with a PAPI of 2.1–3.2,
having baseline Michigan risk score >2 points conferred an 81% probability of subsequent
RVF. For patients with a PAPI of 3.3–6.8, having baseline RV-GLS of -4.9% or better
conferred an 86% probability of no subsequent RVF. The sensitivity and specificity
of this algorithm for predicting postoperative RVF were 67% and 93%, respectively,
with an area under the curve of 0.87.
Conclusion
RV-GLS has an incremental role in predicting the development of RVF post-LVAD implantation,
even after controlling for clinical and haemodynamic parameters.
Keywords
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Article info
Publication history
Published online: April 28, 2022
Accepted:
March 31,
2022
Received in revised form:
February 6,
2022
Received:
October 12,
2021
Footnotes
Dr Bo Xu takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
Nicolas Isaza, Matthew Gonzales, Yoshihito Saijo and Maria Vega Brizneda contributed equally to this work.
Identification
Copyright
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Incremental Value of Strain Imaging in the Multi-Parametric Approach for Evaluation and Prediction of Right Ventricular Failure Post Left Ventricular Assist DeviceHeart, Lung and CirculationVol. 31Issue 11
- PreviewHeart failure (HF) is one of the most common cardiovascular conditions, and its prevalence is rising [1]. In the context of the high demand for transplants and the limited organ donor pool, long-term mechanical circulatory support with left ventricular assist devices (LVAD) has risen as an important treatment strategy for patients with advanced heart failure.
- Full-Text
- Preview
- Predicting Right Ventricular Failure after Left Ventricular Assist Device Implantation: Are We There Yet?Heart, Lung and CirculationVol. 31Issue 11
- PreviewRight ventricular failure (RVF) is the Achilles’ heel of durable left ventricular assist device (LVAD) therapy and causes significant morbidity and mortality in 9–42% of patients following LVAD implantation [1]. Consequently, identifying patients at increased risk for RVF prior to implantation is paramount to guiding patient candidacy, ensuring preoperative right ventricular (RV) optimisation, and individualising postoperative management [2]. Current available RVF predictors are imperfect. Clinical scoring models, such as the Michigan Score, have been the mainstay of risk stratification [3]; however, by utilising preoperative clinical stability and biochemical markers of end-organ function as surrogates for RV function, the Michigan Score cannot provide an actual picture of RV health and thereby misses cases of equivocal or subclinical RV dysfunction [4].
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- Preview
