EUROMACS-RHF Risk Score and 3D Echocardiography as Predictors of Right Heart Failure after Left Ventricular Assist Device Implantation
PURPOSE: Right heart failure (RHF) after LVAD implantation is associated with significant morbidity and mortality. Recently, the EUROMACS-RHF risk score was developed to predict postoperative RHF in this setting. In a single-center analysis, we assessed the added value of 3D-echocardiography for predicting RHF after LVAD implantation. We hypothesized that measuring RV function based on pre-LVAD 3D-echocardiography right ventricle ejection fraction (3D RVEF) further improves the accuracy of predicting RHF. METHODS: We retrospectively studied adult patients who underwent durable LVAD implantation between 2015 and 2018. RV function was evaluated intraoperatively by transesophageal echocardiography (TEE). 3D RVEF was assessed pre-implantation using dedicated software (TomTec Imaging Systems; Figure). Early RHF was defined as need for right ventricular assist device, or inotropic or inhaled pulmonary vasodilator support for >7 postoperative days. Two-sample t-tests were performed for differences between RHF and No-RHF groups. Multivariable logistic regression analysis was conducted to identify independent predictors of RHF. A subset analysis was performed in patients with available 3D RVEF data. RESULTS: A total of 192 patients were studied. RHF occurred in 108 patients (56%). Pre-implant patient characteristics are presented in the Table. We identified two independent predictors of RHF: African-American race (OR=2.32, 95% CI:1.18-4.52, p=0.01) and pre-implant right atrial (pre-RA) pressure (OR=1.12/mmHg, 95% CI:1.04-1.2, p=0.001). EUROMACS-RHF score was not an independent predictor. Among the 79 patients with 3D TEE data included in the subset analysis, 3D RVEF did not independently predict RHF. CONCLUSION: Neither EUROMACS-RHF risk score nor 3D RVEF predicted RHF in our study cohort. African-American race and pre-RA pressure emerged as independent RHF predictors. Predicting RHF remains elusive and will require additional research efforts.
Rosenkrans, D; Qi, W; Cooter, M; Cherry, A; McCartney, S; Hashmi, N; Schroder, J; Milano, C; Podgoreanu, M; Nicoara, A
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