Abstract 18379: Echocardiography for Right Ventricular Failure Prediction After Implantation of Left Ventricular Assist Devices: Preliminary Results From a Prospective Cohort Study
Background: Right ventricular failure (RVF) occurs in 20%-40% of left ventricular assist device (LVAD) recipients. Preoperative clinical scores inadequately predict RVF risk in these patients.
Methods: Beginning 6/2012, all adults with INTERMACS ≥2 profile scheduled for LVAD implantation, without planned right ventricular (RV) support, were prospectively enrolled in an ongoing study evaluating standard and speckle-tracking echocardiographic parameters of RV function for RVF prediction. Preoperative echocardiograms were performed 5±5 days prior to LVAD implantation by study protocol. The primary endpoint was RVF, defined (by INTERMACS) as need for (1) inotropes or pulmonary vasodilators any time past 7 days post-LVAD implant with concomitant high central venous pressure and low cardiac index or (2) mechanical RV support. The secondary endpoint was RVF or death from any cause.
Results: As of 5/2013, 26 patients have been enrolled. Table 1 summarizes the preoperative clinical and hemodynamic characteristics. At 30 days, 7 patients (26.9%) developed RVF and 3 (11.5%) died. Intensive care length of stay (LoS) was 8.0±3.6 days and total LoS was 16.3±9.5 days. Among echocardiographic parameters (Table 2), RV global longitudinal strain (GLS) was the strongest predictor of RVF with a C statistic of 0.86 (95% CI, 0.60-0.99). At a cut-off -6.0%, sensitivity and specificity were 86% and 79%, respectively. Similarly, RV GLS was the strongest predictor of death or RVF combined. Standard RV function parameters were weak outcome predictors.
Conclusion: Among preoperative echocardiographic parameters, RV GLS by speckle tracking appears to be the strongest predictor of post-LVAD RVF.
- © 2013 by American Heart Association, Inc.