Pre‐implant right ventricular free wall strain predicts post‐LVAD right heart failure

Abstract

Background The aim of this study is to evaluate the predictive utility of preoperative right ventricular (RV) global longitudinal strain (GLS) and free wall strain (FWS) on outcomes following left ventricular assist devices (LVADs) implantation. Methods Preoperative transthoracic echocardiograms were retrospectively reviewed in adults undergoing continuous‐flow LVAD implantation between 2004 and 2018 at a single center. Patients undergoing pump exchange were excluded. RV GLS and FWS were calculated using commercially available software with the apical four‐chamber view. The primary outcome was RV failure as defined by the Interagency Registry for Mechanically Assisted Circulatory Support within 1‐year post‐LVAD insertion. Results A total of 333 patients underwent continuous‐flow LVAD implantation during the study period and 137 had adequate preoperative studies for RV strain evaluation. RV FWS was found to be a significant predictor of postoperative RV failure in univariate analysis (odds ratio [OR] = 1.12, p = .03), and this finding persisted after risk adjustment in multivariable analysis (OR = 1.14, p = .04). Using the optimal cutoff value of −5.64%, the c‐index of FWS in predicting RV failure was 0.65. RV GLS was not associated with post‐LVAD RV failure (OR = 1.07, p = .29). PCWP was the only additional significant predictor of RV failure using multivariable analysis (OR = 0.90, p = .02). Conclusion Pre‐implant RV FWS is predictive of RV failure in the first postoperative year after LVAD implantation.

Experience with percutaneous right ventricular support in the early post-left ventricular assist device implantation period (clinical case report and literature reviews)

“…Предложено использовать многочисленные параметры дооперационного лабораторного, гемодинамического, эхокардиографического и МРТобследования для прогнозирования развития ПЖД как в ранние, так и отдаленные сроки после имплантации ЛЖО (табл. 2) [7,[14][15][16]. Продемонстрирована высокая прогностическая значимость не доп ле ровского изображения миокарда (спекл-трекинг эхокардиографии, магнитно-резонансная томография) с определением сегментарной и глобальной деформации ПЖ для прогнозирования развития его дисфункции при различных клинических ситуациях, включая имплантацию ЛЖО [17].…”

Right Ventricular Longitudinal Strain in Patients with Heart Failure

“…The current findings of RV longitudinal strain in RV failure following LV assist device implantation are shown in Table 7 . Dufendach et al [ 15 ] demonstrated that reduced 2D-RVFWLS before LVAD implantation was associated with higher incidence of RV failure after the implantation of a LVAD. Therefore, 2D-RVFWLS was a powerful predictor of RV failure following LVAD implantation.…”

“…In addition, RV dysfunction has been recognized as a powerful independent predictor of poor prognosis [ 11 , 12 ]. Therefore, accurate evaluation of RV function is helpful for risk stratification in patients with HF, so as to guide clinicians to choose the best treatment and improve the prognosis of patients [ 13 , 14 , 15 , 16 , 17 , 18 ]. Currently, cardiac magnetic resonance (CMR) imaging remains the gold standard for RV volumes and function assessment.…”

Predicting, Recognizing, and Treating Right Heart Failure in Patients Undergoing Durable LVAD Therapy

“…However, utility of this measure in predicting RHF is unclear, and reproducibility and availability of the software package are known challenges [ 22 , 40 ]. RV free wall strain has been predictive of RHF following LVAD implantation [ 38 , 41 , 45 , 46 ] and is a promising marker for clinical use.…”