The Incremental Value of Right Ventricular Size and Strain in the Risk Assessment of Right Heart Failure Post - Left Ventricular Assist Device Implantation.

Right heart failure (RHF) after left ventricular assist device (LVAD) implantation is associated with high morbidity and mortality. Existing risk scores include semiquantitative evaluation of right ventricular (RV) dysfunction. This study aimed to determine whether quantitative evaluation of both RV size and function improve risk stratification for RHF after LVAD implantation beyond validated scores. From 2009 to 2015, 158 patients who underwent implantation of continuous-flow devices who had complete echocardiographic and hemodynamic data were included. Quantitative RV parameters included RV end-diastolic (RVEDAI) and end-systolic area index, RV free-wall longitudinal strain (RVLS), fractional area change, tricuspid annular plane systolic excursion, and right atrial area and pressure. Independent correlates of early RHF (<30 days) were determined with the use of logistic regression analysis. Mean age was 56 ± 13 years, with 79% male; 49% had INTERMACS profiles ≤2. RHF occurred in 60 patients (38%), with 20 (13%) requiring right ventricular assist device. On multivariate analysis, INTERMACS profiles (adjusted odds ratio 2.38 [95% confidence interval [CI] 1.47-3.85]), RVEDAI (1.61 [1.08-2.32]), and RVLS (2.72 [1.65-4.51]) were independent correlates of RHF (all P < .05). Both RVLS and RVEDAI were incremental to validated risk scores (including the EUROMACS score) for early RHF after LVAD (all P < .01). RV end-diastolic and strain are complementary prognostic markers of RHF after LVAD implantation.

Aymami M ，Amsallem M ，Adams J ，Sallam K ，Moneghetti K ，Wheeler M ，Hiesinger W ，Teuteberg J ，Weisshaar D ，Verhoye JP ，Woo YJ ，Ha R ，Haddad F ，Banerjee D ... -  《-》

Risk factors for the development of right ventricular failure after left ventricular assist device implantation-a single-centre retrospective with focus on deformation imaging.

Right heart failure (RHF) after the implantation of a left ventricular assist device (LVAD) remains a dreaded postoperative complication. Using 2D speckle-tracking echocardiography, it is possible to acquire right ventricular global and regional function. The aim of our study was to assess whether speckle-tracking echocardiography values will better predict the RHF post-continuous-flow LVAD implantation. From January 2014 to January 2016, 54 patients who underwent LVAD implantation were included and retrospectively analysed. Clinical, invasive haemodynamic (right and left heart catheterization), laboratory and transthoracic echocardiography data were reviewed. Multivariable logistic regression was performed using RHF as dependent variable. Thirteen patients (24%) developed RHF. These patients had significantly elevated procalcitonin (P = 0.011), elevated central venous pressure (CVP) pre- and post-LVAD implantation (P = 0.002 and 0.031, respectively), higher right ventricular (RV) and pulmonary systolic pressure (P = 0.016 and 0.013, respectively), higher Michigan Risk Score (P = 0.001) and a lower peak systolic longitudinal strain of the basal RV free wall (P = 0.032). Haemoglobin, procalcitonin, RV systolic pressure, basal right ventricular free wall and pre-CVP entered the final multivariable analysis, only basal right ventricular free wall (P < 0.001) and pre-CVP (P < 0.001) remained significant predictors of RHF. The sensitivity and specificity of the final model were 85.7% and 95.4%, respectively. The negative predictive value reached 94%. 2D strain parameters of the RV free wall seem to be auspicious for RV function and predicting RHF. Moreover, intraoperative CVP should not be neglected since elevated values proved to be highly associated with RHF. Our results represent a valuable supplement to other scores by considering both echocardiography and intraoperative data.

Boegershausen N ，Zayat R ，Aljalloud A ，Musetti G ，Goetzenich A ，Tewarie L ，Moza A ，Amerini A ，Autschbach R ，Hatam N ... -  《-》

Right ventricular free wall longitudinal strain and stroke work index for predicting right heart failure after left ventricular assist device therapy.

Right heart failure (RHF) is an important prognostic factor in continuous-flow left ventricular assist device (LVAD) therapy. We aimed to assess the clinical variables associated with RHF after LVAD implantation and to compare their performance against currently available RHF predictive scoring systems. The study cohort comprised 57 patients who underwent LVAD therapy between January 2012 and May 2018 in our centre. The mean age of the patients was 39.9 ± 18.3 years, and 43 (81.1%) of them were men. Thirty-eight patients (66.6%) were in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile I or II. The study cohort was divided into the patients with RHF postoperatively (n = 20, 35.1%) and without RHF (n = 37, 64.9%). Independent predictors for RHF were preoperative right ventricular ejection fraction <25% [odds ratio (OR) 4.68, 95% confidence interval (CI) 1.41-15.5; P = 0.01], right ventricular stroke work index <400 mmHg ml-1 (OR 3.73, 95% CI 1.01-13.7; P = 0.04), right ventricular outflow tract systolic excursion <7 mm (OR 1.55, 95% CI 0.31-0.84; P = 0.002), right ventricular outflow tract fractional shortening <15% (OR 1.62, 95% CI 0.34-0.78; P = 0.02), right ventricular free wall longitudinal strain ≤19% (OR 3.13, 95% CI 1.01-2.43; P = 0.003), right ventricular fractional area change <27% (OR 3.71, 95% CI 1.15-11.9; P = 0.02) and prealbumin <14 mg/dl (OR 3.45, 95% CI 1.07-11.03; P = 0.03). Modest diagnostic performance for RHF was detected in 4 of 7 validated scoring systems with resulting area under the curve values of 0.70 (95% CI 0.55-0.84; P = 0.001) for the Seattle Heart Failure Model; 0.68 (95% CI 0.49-0.81, P = 0.03) for the Fitzpatrick's; 0.68 (95% CI 0.53-0.83, P = 0.028) for the acute physiology and chronic health evaluation (APACHE) II; and 0.66 (95% CI 0.50-0.82, P = 0.04) for the model for end-stage liver disease scoring systems. However, we found best discrimination performance of the score with a resulting area under the curve value of 0.94 (95% CI 0.55-0.89, P = 0.03) for right ventricular free wall longitudinal strain ≥-15.5% and 0.82 for right ventricular stroke work index <400 mmHg ml-1 m-2 in predicting RHF. Right ventricular free wall longitudinal strain ≥-15.5% and right ventricular stroke work index <400 mmHg ml-1 m-2 were independent predictors of RHF following LVAD implantation. Currently available prediction risk scores had the modest power of accuracy in the low INTERMACS profile Turkish population.

Gumus F ，Durdu MS ，Cakici M ，Kurklu TST ，Inan MB ，Dincer I ，Sirlak M ，Akar AR ... -  《-》

Pulmonary Arterial Elastance and INTERMACS-Defined Right Heart Failure Following Left Ventricular Assist Device.

Muslem R ，Ong CS ，Tomashitis B ，Schultz J ，Ramu B ，Craig ML ，Van Bakel AB ，Gilotra NA ，Sharma K ，Hsu S ，Whitman GJ ，Leary PJ ，Cogswell R ，Lozonschi L ，Houston BA ，Zijlstra F ，Caliskan K ，Bogers AJJC ，Tedford RJ ... -  《-》

Echocardiographic predictors of adverse outcomes after continuous left ventricular assist device implantation.

The purpose of the study was to identify echocardiographic predictors of adverse outcome in patients implanted with continuous-flow left ventricular assist devices (LVAD). Continuous flow LVAD have become part of the standard of care for the treatment of advanced heart failure. However, knowledge of echocardiographic predictors of outcome after LVAD are lacking. Overall, 83 patients received continuous-flow LVAD (HeartMate II, Thoratec Corporation, Pleasanton, California) from February 2007 to June 2010. The LVAD database, containing various echocardiographic parameters, was examined to analyze their influence on in-hospital mortality, a compound cardiac event (in-hospital mortality or acute right ventricular [RV] dysfunction), and long-term mortality. Eight patients died before discharge (operative mortality 9.6%), and another 15 patients were considered to have acute RV dysfunction immediately after surgery. Patients with relatively small left ventricular end-diastolic diameters (<63 mm) had significantly higher risk for in-hospital mortality (odds ratio [OR]: 0.9; 95% confidence interval [CI]: 0.83 to 0.99; p = 0.04) or occurrence of the compound cardiac event (OR: 0.89; 95% CI: 0.84 to 0.95; p < 0.001). The most significant predictor of outcome was the decreased timing interval between the onset and the cessation of tricuspid regurgitation flow corrected for heart rate (TRDc), a surrogate for early systolic equalization of RV and right atrial pressure. Short TRDc predicted in-hospital mortality (OR: 0.85; 95% CI: 0.74 to 0.97; p = 0.01) and the compound cardiac event (OR: 0.83; 95% CI: 0.74 to 0.91; p < 0.0001). Multivariate analysis based on a logistic regression model demonstrated that the accuracy of predicting the 30-day compound adverse outcome was improved with the addition of echocardiographic variables when added to the commonly used hemodynamic or clinical scores. TRDc predicted long-term survival, with adjusted risk ratios of 0.89 for death from any cause (95% CI: 0.83 to 0.96; p = 0.003) and 0.88 for cardiac-related death (95% CI: 0.77 to 0.98; p = 0.03). The presence of either a relatively small left ventricle (<63 mm) or early systolic equalization of RV and right atrial pressure (short TRDc) demonstrated by echocardiography is associated with increased 30-day morbidity and mortality. Prediction of early adverse outcomes by echocardiographic parameters is additive to laboratory or hemodynamic variables.

Topilsky Y ，Oh JK ，Shah DK ，Boilson BA ，Schirger JA ，Kushwaha SS ，Pereira NL ，Park SJ ... -  《-》