Clinical Research
Heart Failure
Independent and Incremental Role of Quantitative Right Ventricular Evaluation for the Prediction of Right Ventricular Failure After Left Ventricular Assist Device Implantation

https://doi.org/10.1016/j.jacc.2012.02.073Get rights and content
Under an Elsevier user license
open archive

Objectives

This study sought to determine the utility of quantitation of right ventricular (RV) function in predicting RV failure in patients undergoing left ventricular assist device (LVAD) implantation.

Background

Clinical evaluation alone seems insufficient for predicting RV failure, an important cause of morbidity and mortality after LVAD implantation.

Methods

Clinical, hemodynamic, and echocardiographic data were collected on 117 patients undergoing LVAD implantation. Standard pre-procedural echocardiographic RV measurements were supplemented by velocity vector imaging of RV free wall longitudinal strain. RV failure was defined as the need for placement of an RV assist device, or the use of inotropic agents for >14 days. Receiver operating characteristic curves were derived, with resampling to generate valid estimates of prediction accuracy. A net reclassification index was calculated for comparison of risk scores.

Results

RV failure occurred in 47 of 117 patients (40%). There was a significant difference in peak strain between patients with and without RV failure (–9.0% vs. –12.2%; p < 0.01). A peak strain cutoff of –9.6% predicted RV failure with 76% specificity and 68% sensitivity. In a multivariate logistic regression analysis including variables from the established Michigan RV risk score, peak strain remained an independent predictor of RV failure. RV strain was incremental to the Michigan risk score as a predictor of RV failure (area under the receiver operating characteristic curve: 0.77 vs. 0.66; p < 0.01). The net reclassification index with strain was +10.4%.

Conclusions

Reduced RV free wall peak longitudinal strain was associated with an increased risk for RV failure among patients undergoing LVAD implantation.

Key Words

assist device
heart failure
right ventricle
strain

Abbreviations and Acronyms

AUC
area under the curve
LV
left ventricle
LVAD
left ventricular assist device
RV
right ventricle
RVAD
right ventricular assist device

Cited by (0)

Dr. Starling has received research support and modest honoraria from Thoratec. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.