title: Echocardiographic variables after left ventricular assist device implantation associated with adverse outcome.
abstract: BACKGROUND
  Operative mortality after left ventricular assist device (LVAD) implantation is heavily influenced by patient selection and the technical difficulty of surgery. However, how we treat our patients and LVAD setting may affect the patient outcome beyond this period. We postulated that the presence of echocardiographic variables 1 month after surgery suggesting appropriate degree of LV unloading and an adequate forward flow would be important in determining clinical outcomes after the initial successful LVAD implantation.
  
  
  RESULTS
  We retrospectively analyzed various variables in echocardiographic examinations performed 30 days after LVAD implant in 76 consecutive patients receiving continuous flow device for their association with a compound end point (90-day mortality, readmission for heart failure, or New York Heart Association class III or higher at the end of the 90-day period). The echocardiographic associations examined included estimated LVAD flow, with and without native LV contribution, interventricular septal position, the status of aortic valve opening, an estimated left atrial pressure (ELAP), the mitral flow E-wave deceleration time, and the ratio of deceleration time to E-wave velocity (mitral deceleration index [MDI]). Four patients died during the 30- to 90-day period, 6 patients were readmitted for heart failure, and 25 patients were considered to have New York Heart Association class III or higher at the end of the 90-day period. Variables associated with adverse outcome included increased ELAP (odds ratio, 1.30 [1.16-1.48]; P<0.0001), MDI <2 ms/[cm/s] (odds ratio, 4.4 implantation [1.22-18]; P=0.02) and decreased tricuspid lateral annulus velocity (odds ratio, 0.70 implantation [0.48-0.95]; P=0.02). A leftward deviation of interventricular septum was associated with a worse outcome (odds ratio, 3.03 implantation [1.21-13.3]; P=0.01).
  
  
  CONCLUSIONS
  Mortality and heart failure after LVAD surgery appear to be predominantly determined by echocardiographic evidence of inefficient unloading of the left ventricle and persistence of right ventricular dysfunction. Increased estimated LA pressure and short MDI are associated with worse mid term outcome. Leftward deviation of the septum is associated with worse outcome as well.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Yan
authors.initials: Y
authors.lastname: Topilsky
authors.forename: Tal
authors.initials: T
authors.lastname: Hasin
authors.forename: Jae K
authors.initials: JK
authors.lastname: Oh
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Borgeson
authors.forename: Barry A
authors.initials: BA
authors.lastname: Boilson
authors.forename: John A
authors.initials: JA
authors.lastname: Schirger
authors.forename: Alfredo L
authors.initials: AL
authors.lastname: Clavell
authors.forename: Robert P
authors.initials: RP
authors.lastname: Frantz
authors.forename: Rayji
authors.initials: R
authors.lastname: Tsutsui
authors.forename: Mingya
authors.initials: M
authors.lastname: Liu
authors.forename: Simon
authors.initials: S
authors.lastname: Maltais
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: D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D016017:Odds Ratio; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality*