title: Echocardiographic predictors of adverse outcomes after continuous left ventricular assist device implantation.
abstract: OBJECTIVE
  The purpose of the study was to identify echocardiographic predictors of adverse outcome in patients implanted with continuous-flow left ventricular assist devices (LVAD).
  
  
  BACKGROUND
  Continuous flow LVAD have become part of the standard of care for the treatment of advanced heart failure. However, knowledge of echocardiographic predictors of outcome after LVAD are lacking.
  
  
  METHODS
  Overall, 83 patients received continuous-flow LVAD (HeartMate II, Thoratec Corporation, Pleasanton, California) from February 2007 to June 2010. The LVAD database, containing various echocardiographic parameters, was examined to analyze their influence on in-hospital mortality, a compound cardiac event (in-hospital mortality or acute right ventricular [RV] dysfunction), and long-term mortality.
  
  
  RESULTS
  Eight patients died before discharge (operative mortality 9.6%), and another 15 patients were considered to have acute RV dysfunction immediately after surgery. Patients with relatively small left ventricular end-diastolic diameters (<63 mm) had significantly higher risk for in-hospital mortality (odds ratio [OR]: 0.9; 95% confidence interval [CI]: 0.83 to 0.99; p = 0.04) or occurrence of the compound cardiac event (OR: 0.89; 95% CI: 0.84 to 0.95; p < 0.001). The most significant predictor of outcome was the decreased timing interval between the onset and the cessation of tricuspid regurgitation flow corrected for heart rate (TRDc), a surrogate for early systolic equalization of RV and right atrial pressure. Short TRDc predicted in-hospital mortality (OR: 0.85; 95% CI: 0.74 to 0.97; p = 0.01) and the compound cardiac event (OR: 0.83; 95% CI: 0.74 to 0.91; p < 0.0001). Multivariate analysis based on a logistic regression model demonstrated that the accuracy of predicting the 30-day compound adverse outcome was improved with the addition of echocardiographic variables when added to the commonly used hemodynamic or clinical scores. TRDc predicted long-term survival, with adjusted risk ratios of 0.89 for death from any cause (95% CI: 0.83 to 0.96; p = 0.003) and 0.88 for cardiac-related death (95% CI: 0.77 to 0.98; p = 0.03).
  
  
  CONCLUSIONS
  The presence of either a relatively small left ventricle (<63 mm) or early systolic equalization of RV and right atrial pressure (short TRDc) demonstrated by echocardiography is associated with increased 30-day morbidity and mortality. Prediction of early adverse outcomes by echocardiographic parameters is additive to laboratory or hemodynamic variables.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Yan
authors.initials: Y
authors.lastname: Topilsky
authors.forename: Jae K
authors.initials: JK
authors.lastname: Oh
authors.forename: Dipesh K
authors.initials: DK
authors.lastname: Shah
authors.forename: Barry A
authors.initials: BA
authors.lastname: Boilson
authors.forename: John A
authors.initials: JA
authors.lastname: Schirger
authors.forename: Sudhir S
authors.initials: SS
authors.lastname: Kushwaha
authors.forename: Naveen L
authors.initials: NL
authors.lastname: Pereira
authors.forename: Soon J
authors.initials: SJ
authors.lastname: Park
mesh_terms: D000208:Acute Disease; D000368:Aged; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D015588:Observer Variation; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right