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Heart, Lung and Circulation

Incremental Value of Global Longitudinal Strain to Michigan Risk Score and Pulmonary Artery Pulsatility Index in Predicting Right Ventricular Failure Following Left Ventricular Assist Devices

  • Nicolas Isaza
    Affiliations
    Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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  • Matthew Gonzalez
    Affiliations
    Spectrum Health Hospitals Advanced Heart Failure Clinic, Grand Rapids, MI, USA
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  • Yoshihito Saijo
    Affiliations
    Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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  • Maria Vega Brizneda
    Affiliations
    Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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  • Jerry Estep
    Affiliations
    Section of Heart Failure and Transplantation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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  • Randall C. Starling
    Affiliations
    Section of Heart Failure and Transplantation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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  • Chonyang Albert
    Affiliations
    Section of Heart Failure and Transplantation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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  • Edward Soltesz
    Affiliations
    Department of Thoracic and Cardiovascular Surgery, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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  • Michael Zhen-Yu Tong
    Affiliations
    Department of Thoracic and Cardiovascular Surgery, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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  • Nicholas Smedira
    Affiliations
    Department of Thoracic and Cardiovascular Surgery, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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  • Richard A. Grimm
    Affiliations
    Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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  • Brian P. Griffin
    Affiliations
    Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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  • Zoran B. Popovic
    Affiliations
    Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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  • Bo Xu
    Correspondence
    Corresponding author at: Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Desk J1-5, 9500 Euclid Ave, Cleveland, OH, 44195, USA
    Affiliations
    Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
    Search for articles by this author
Published:April 28, 2022DOI:https://doi.org/10.1016/j.hlc.2022.03.012

      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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      Linked Article

      • Incremental Value of Strain Imaging in the Multi-Parametric Approach for Evaluation and Prediction of Right Ventricular Failure Post Left Ventricular Assist Device
        Heart, Lung and CirculationVol. 31Issue 11
        • Preview
          Heart 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
        • PDF
      • Predicting Right Ventricular Failure after Left Ventricular Assist Device Implantation: Are We There Yet?
        Heart, Lung and CirculationVol. 31Issue 11
        • Preview
          Right 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].
        • Full-Text
        • PDF