Clinical Scores and Echocardiography for Right Ventricular Failure Risk Prediction after Implantation of Continuous-Flow Left Ventricular Assist Devices

Purpose Clinical scores for right ventricular failure (RVF) risk after left ventricular assist device implantation (LVAD) were developed in mostly pulsatile-flow LVAD populations, whereas most patients currently receive continuous-flow LVADs. Methods and Materials We evaluated the Michigan, Penn, and Utah scores and multiple pre-operative echocardiographic parameters for 90-day RVF prediction in 69 patients who underwent HeartMate-II (N=58) or HeartWare (N=11) implantation in 2007-2011. Results Baseline characteristics are presented in Table 1 . Overall 18 patients (26.1%) experienced RVF (defined as ≥48h NO use; multi-organ failure due to RVF; inotropes for ≥14 days post-LVAD; or re-institution of inotropes). Among clinical scores, only Michigan predicted RVF (OR per point: 1.29; 95% CI: 1.04, 1.59; P=0.02) but discrimination was modest (C=0.64, P=0.093; sensitivity: 50%; specificity: 78.4%). Penn (C=0.50; P=0.99) and Utah (C=0.52; P=0.78) scores did not discriminate RVF. Among echocardiographic parameters, only a smaller left atrial diameter (OR per -10 mm: 2.36; 95% CI: 1.01, 5.45; P=0.045) was associated with RVF and, when added to, improved discrimination of Michigan score to C=0.76 (P Conclusions RVF risk prediction scores developed for pulsatile LVADs are suboptimal for patients with continuous-flow LVADs. Baseline clinical and echocardiographic characteristics (N=69) Patients with RVF (N=18) Patients without RVF (N=51) P Age, yrs 55.2±9.4 48.9±13.9 0.078 Male, % 61.1 47.1 0.56 Ischemic HF, % 27.8 29.4 1.00 Intra-aortic balloon pump pre-op, % 38.9 25.5 0.37 Inotropes pre-op, % 100 96.1 1.00 Pressors pre-op, % 11.1 5.9 0.60 Bilirubin, mg/dL 1.6±0.9 1.6±1.1 0.77 AST, U/L 58 (35, 127) 30 (23, 39) 0.002 Creatinine, mg/dL 2.0±0.7 1.6±1.0 0.014 Cardiac index, L/m 2 1.75±0.50 1.75±0.43 0.86 RV stroke work index, mmHg a l/min 0.52±0.26 0.49±0.24 0.50 LV ejection fraction, % 18.8±4.8 19.1±5.1 0.54 Left atrial diameter, mm 47±6 52±8 0.034 RV fractional area change, % 30.0±6.0 27.8±8.0 0.14