Abstract 2439: Invasive Right Ventricular Hemodynamics and Tricuspid Annular Plane Systolic Excursion to Predict Right Ventricular Dysfunction After Left Ventricular Assist Device Implantation
Introduction: Right ventricular (RV) failure is a major cause of morbidity and mortality in heart failure patients undergoing destination left ventricular assist device (LVAD) implantation. Using tricuspid annular plane systolic excursion (TAPSE; an echo based measure of RV function linked to mortality in patients with pulmonary arterial hypertension) and invasive measurement of RV systolic function (dP/dtmax/IP; dP/dt max normalized to instantaneous pressure) we hypothesized that these parameters correlate with the incidence of RV failure post LVAD implantation.
Methods: 65 consecutive patients with heart failure and clinical indication for LVAD implantation were prospectively evaluated. All patients underwent transthoracic echocardiography and right heart catheterization within 14 days prior to implantation. TAPSE was measured by M-mode echocardiography as the mean displacement (cm) of the tricuspid annular plane towards the RV apex from end-diastole to end-systole over 3 to 5 cycles. RVFAC was measured as the percent change in RV area from end diastole to end systole as measured in the apical four chamber view. Pressure-dependent measures of RV function were derived from PA catheterization based RV waveforms analyzed using pressure volume loop software (WinPVAN 3.5.8). RV failure post LVAD was defined as IV inotrope therapy requirement >14 days, inhaled NO use >48 hrs, death due to decompensated RV failure, or RVAD implantation. Clinical, hemodynamic and echo data were compared in patients with RV Failure (group I; n=14) vs. those without RV failure (group II; n=51).
Results : Groups I and II had similar mean pulmonary arterial pressure, cardiac index, systolic blood pressure, baseline liver function test values, and renal function (P>0.05). Group I had higher right atrial pressure (14±5vs.11±4 mmHg; *p<0.05). TAPSE of less than 1.8 cm and dP/dtmax/IP of less than 10 correlated strongly with RV failure post LVAD implantation (P<0.005 and P<0.001, respectively) while RVFAC showed no correlation.
Conclusions: TAPSE and the load-independent index dP/dt max/IP correlate strongly with RV failure post-LVAD implantation. These data provide the basis for future study of these endpoints in patients with heart failure and RV dysfunction.