Abstract 11333: Incremental Value of Peak Longitudinal Strain in the Prediction of Right Ventricular Failure after Left Ventricular Assist Device Implantation
Background Right ventricular failure (RVF) is an important cause of morbidity and mortality after implantation of left ventricular assist devices. We sought the utility of RV free wall peak longitudinal strain (RVLS) in predicting the occurrence of RVF.
Methods Clinical, hemodynamic and echocardiographic data were collected on 117 patients undergoing left ventricular assist device implantation. RVF was defined as need for placement of an RV assist device, or use of inotropic agents for >14 days. Velocity vector imaging was used to measure RVLS on pre-procedural echocardiograms.
Results RVF occurred in 47 of 117 patients (40%). There was a significant difference in RVLS between patients with and without RVF (-9.0% vs. -12.2%, p<0.001). The group with RVF also had lower cardiac index (2.07 vs. 2.36 L/min/m2, p<0.01) and higher pulmonary vascular resistance (3.7 vs. 2.3 Wood units, p=0.02). Tricuspid annular systolic excursion and RV fractional area change did not differ between groups. A cutoff value of -9.6% for RVLS predicted RVF with a specificity of 76% and sensitivity of 68% with an area under the ROC curve of 0.70 (Figure). In a multivariate logistic regression analysis including variables from the established Michigan RV risk score, RVLS was an independent predictor of RVF, comparable to other predictors (Table).
Conclusion Reduced RVLS is associated with increased risk of RVF among patients undergoing left ventricular assist device implantation. When multivariate modeling was performed, RVLS added incremental benefit to known predictors of RVF. This may provide further insight into risk stratification and device selection in these patients.
- © 2011 by American Heart Association, Inc.