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.

Duke Scholars

Author Carmelo Alessio Milano Surgery, Cardiovascular and Thoracic Surgery

Author Mihai V. Podgoreanu Anesthesiology, Cardiothoracic

Author Jacob Niall Schroder Surgery, Cardiovascular and Thoracic Surgery

Author Anne Cherry Anesthesiology

Author Alina Nicoara Anesthesiology, Cardiothoracic

Author Sharon Lorraine McCartney Anesthesiology, Cardiothoracic

Author Nazish Khalid Hashmi Anesthesiology, Cardiothoracic