Author + information
- Rey Percival Vivo,
- Molham Aldeiri,
- Andrea Cordero-Reyes,
- Paulino Alvarez,
- Matthias Loebe,
- Brian Bruckner,
- Guillermo Torre-Amione,
- Arvind Bhimaraj,
- Barry Trachtenberg and
- Jerry Estep
Early and late right ventricular failure (RVF) remains a major cause of mortality and morbidity, respectively, in patients with continuous-flow LVAD. Transthoracic echocardiographic (TTE) predictors of early RVF have been described but those predictive of late RVF are unclear. We aimed to compare pre-implant TTE predictors of early vs. late RVF in this group.
Two-dimensional and Doppler TTE parameters pre-LVAD were analyzed from 171 patients from 2004-2012. Early RVF (<30 days) was defined as requirement of RVAD or >14 consecutive days of inotropic support. Late RVF (>30 days) was defined as a syndrome of symptoms/signs (e.g. dyspnea/fatigue and jugular venous distention/leg edema) requiring in- or out-patient augmentation of therapy (e.g. increase in diuretic dosing/LVAD pump speed). Univariate analysis using a logistic regression model was done to determine predictors of outcome.
Overall, 11% had early RVF while 25% had late RVF (mean time to late event: 216 days). Increased RV: LV diameter ratio (OR 3.03, Cl 1.19-7.72, P=0.020) and RV basal diameter (OR 5.8, Cl 1.28-26.3, P=0.023) were significant predictors of early RVF. Elevated right atrial pressure (RAP) (OR 1.16, Cl 1.04-1.30, P=0.006) and RAP: E/e’ ratio (OR 3.87, Cl 1.01-14.79, P=0.04) were strong predictors of late RVF. Based on ROC curves, the optimal threshold for the RV/LV diameter ratio and RV basal diameter to predict early RVF were >0.75 and >4.3 cm, respectively; thresholds for RAP and RAP: E/e’ ratio to predict the late outcome were >15 mmHg and >0.85, respectively.
RVF is a clinical challenge in patients with continuous-flow LVAD and can occur at any time. Increased RV: LV diameter ratio and RV basal diameter, indices of pre-LVAD adverse RV remodeling, are associated with higher risk of early RVF whereas increased RAP and RAP: E/e’ ratio, surrogates of elevated RV relative to LV filling pressures, correlate with higher risk of late RVF. TTE predictors of early vs. late RVF are different and may guide therapeutic intervention.
Moderated Poster Contributions
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Mechanical Circulatory Support: Assessment of Risk and Outcomes
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1307M-284
- 2013 American College of Cardiology Foundation