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Early right ventricular failure (RVF) after LVAD placement is clinically difficult to predict. We report mean arterial pressure (MAP) to central venous pressure (CVP) ratio in predicting early RVF.
212 consecutive patients with pre-LVAD hemodynamics were retrospectively enrolled. An ROC curve of MAP/CVP ratio was acquired and a ratio of 7.5 was obtained (AUC = 0.65, Figure 1A). Patients were stratified by a MAP/CVP ratio of 7.5. The incidence of early RV failure (defined as inotropic support need for > 2 weeks or need for RVAD), and mortality data were recorded. Kaplan-Meier (KM) survival analysis, Binary logistic regression and Cox survival testing were performed.
111 patients (52%) had MAP/CVP of less than 7.5, while 101 patients (48%) had a ratio ≥7.5. Patients with MAP/CVP <7.5 had a higher incidence of post-LVAD RV failure [49 (44%) vs. 23 (22.8%), p=0.001]. Similarly, RVAD requirement was higher in MAP/CVP < 7.5 group (10.8% vs. 2%, p=0.01). Overall survival was poor in the study group (55% vs. 72%, p=0.009). KM analysis confirmed a poor survival in this cohort. (Log rank p = 0.012) (Figure1B). A binary logistic regression to adjust for baseline differences in the univariate analysis, confirmed that MAP/CVP < 7.5 was an independent predictor of early RVF (OR 0.49 95% CI 0.25-0.95, p =0.03).
Our findings suggest that pre-LVAD MAP/CVP <7.5 is a predictor of early RV failure and overall mortality. Prospective studies to validate our findings are warranted.
Poster Area, South Hall A1
Saturday, April 02, 2016, 3:45 p.m.-4:30 p.m.
Session Title: Heart Transplant and LVADs: New Approaches to Old Issues
Abstract Category: 26. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1136-062
- 2016 American College of Cardiology Foundation