1. Right ventricular response to pulsatile load is associated with early right heart failure and mortality after left ventricular assist device
- Author
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Pavan Atluri, J. Eduardo Rame, Payman Zamani, Kenneth B. Margulies, Ryan J. Tedford, Jeremy A. Mazurek, Edo Y. Birati, E. Wilson Grandin, Julio A. Chirinos, Esther Vorovich, and Gregory S. Troutman
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Time Factors ,Heart Ventricles ,Ventricular Dysfunction, Right ,medicine.medical_treatment ,Diastole ,Hemodynamics ,Pulmonary Artery ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Afterload ,Risk Factors ,medicine.artery ,Internal medicine ,medicine ,Humans ,Pulmonary Wedge Pressure ,Pulmonary wedge pressure ,Retrospective Studies ,Heart Failure ,Body surface area ,Transplantation ,business.industry ,Stroke Volume ,Stroke volume ,Middle Aged ,United States ,Surgery ,Survival Rate ,030228 respiratory system ,Pulsatile Flow ,Ventricular assist device ,Pulmonary artery ,Cardiology ,Equipment Failure ,Female ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background Right ventricular (RV) adaptation to afterload is crucial for patients undergoing continuous-flow left ventricular assist device (cf-LVAD) implantation. We hypothesized that stratifying patients by RV pulsatile load, using pulmonary arterial compliance (PAC), and RV response to load, using the ratio of central venous to pulmonary capillary wedge pressure (CVP:PCWP), would identify patients at high risk for early right heart failure (RHF) and 6-month mortality after cf-LVAD. Methods During the period from January 2008 to June 2014, we identified 151 patients at our center with complete hemodynamics prior to cf-LVAD. Pulsatile load was estimated using PAC indexed to body surface area (BSA), according to the formula: indexed PAC (PACi) = [SV / (PA systolic – PA diastolic )] / BSA, where SV is stroke volume and PA is pulmonary artery. Patients were divided into 4 hemodynamic groups by PACi and CVP:PCWP. RHF was defined as the need for unplanned RVAD, inotropic support ≥14 days or death due to RHF within 14 days. Risk factors for RHF and 6-month mortality were examined using logistic regression and Cox proportional hazards modeling. Results Sixty-one patients (40.4%) developed RHF and 34 patients (22.5%) died within 6 months. Patients with RHF had lower PACi (0.92 vs 1.17 ml/mm Hg/m 2 , p=0.008) and higher CVP:PCWP (0.48 vs 0.37, p=0.001). Higher PACi was associated with reduced risk of RHF (adjusted odds ratio [adj-OR] 0.61, 95% confidence interval [CI] 0.39 to 0.94, p=0.025) and low PACi with increased risk of 6-month mortality (adjusted hazard ratio [adj-HR] 3.18, 95% CI 1.40 to 7.25, p=0.006). Compared to patients with low load (high PACi) and adequate right heart response to load (low CVP:PCWP), patients with low PACi and high CVP:PCWP had an increased risk of RHF (OR 4.74, 95% CI 1.23 to 18.24, p=0.02) and 6-month mortality (HR 8.68, 95% CI 2.79 to 26.99, p Conclusions A hemodynamic profile combining RV pulsatile load and response to load identifies patients at high risk for RHF and 6-month mortality after cf-LVAD.
- Published
- 2017
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