Electromechanical Activation Time via HemoTag Correlation with Pulmonary Artery Pressure by Right Heart Catheterization: Implications for Diagnosis and Clinical Practice

Abstract

Background: Left ventricular assist devices (LVAD) improve functional class and survival in selected patients with advanced heart failure. Right Ventricular Failure (RVF) after LVAD implantation is associated with increased mortality, morbidity and hospitalization. Identification of LVAD candidates at risk for RVF remains challenging. The purpose of this research is to determinate association of clinical and echocardiographic parameters with early and late RVF, clinical outcomes, and mortality after LVAD implantation. Methods: We retrospectively reviewed 156 consecutive LVAD implantations at the University of Florida at Gainesville, FL, from 2006 to 2016. Clinical and transthoracic echocardiographic data were studied. Early RVF was defined as the unplanned need for a right ventricular assist device or inotrope dependence for ≥14 days. Late RVD defined as either starting IV inotropes after 6 months of LVAD implantation or need for LVAD speed reduction after 6 months of LVAD implantation. Results: Data were collected for 91 patients whose longitudinal follow up data were available. Our cohort was predominantly males (78%) with a mean age of 59.1 years. Early RVF was detected in 27 patients (29.7%) late RVF was detected in 10 patients (11%). Obesity was associated with increased late RVF (P = .035). There was a negative correlation between pre-implantation right ventricular diameter and late RVF (r = −250, P = .021), however, it did not predict RVF on linear regression analysis. Pre-implantation echocardiographic right ventricular parameters such as tricuspid regurgitation severity, right ventricular fractional area change, and tricuspid annular excursion showed no correlation with post-LVAD implantation RVF, hospitalization, or mortality. Conclusions: Right ventricular dilation was inversely related to the development of late RVF after LVAD implantation, but predictors may extend beyond routine echocardiographic parameters. In our institution, these parameters were not predictive of outcomes. Obesity was associated with late RVF suggesting that patient factors play an important role in this disease process. There is need for in-depth investigation of the pathophysiological changes to the right ventricular in LVAD patients. Our results also highlight the responsibility for centers to determine center-specific risk factors and approaches to RVF.