Abstract 16473: Decreased Right Ventricular Strain Before Left Ventricular Assist Device Implantation is Associated With Adverse Early Outcome
Background: Right ventricular (RV) dysfunction predicts poor outcome in patients (Pts) undergoing left ventricular assist device (LVAD) implantation but accurate quantification of RV dysfunction by 2D and Doppler echocardiography is difficult. RV strain echocardiography is a newer technique which has been used to quantify RV function in other populations. Therefore, we sought to determine whether RV strain echocardiography could identify high risk Pts prior to LVAD implantation.
Methods: All consecutive Pts who underwent continuous flow LVAD implantation between February 2007 and June 2010, with adequate echo images for strain analysis were included. RV free wall longitudinal strain was retrospectively analyzed using the Syngo VVI (Siemens, version 2.0) platform to determine the impact of RV strain on the 30 day composite endpoint of all cause mortality or RV failure (defined as need bail-out RV assist device or inotropic support for more than 7 days ) following LVAD implantation.
Result: Amongst 83 Pts, 60 had adequate echo images for RV strain analysis and were included. Of these, 16 died or suffered acute RV failure within 30 days after LVAD implantation. Baseline characteristics according to 30 day outcome are shown in Table. There was no difference in age, baseline hemoglobin or renal function amongst Pts with good outcome vs. those who had poor 30 day outcome. In univariate risk modeling, low RV strain was a predictor of poor 30 day outcomes (OR 0.83, 95%CI 0.70-0.95, P =0.016, AUC=0.71).
Conclusion: In addition to right ventricular index of myocardial performance and corrected tricuspid regurgitation flow duration, decreased RV free wall longitudinal strain is associated with increased 30-day mortality and RV failure after LVAD implantation and may be useful in selecting Pts most likely to benefit.
- © 2011 by American Heart Association, Inc.