title: Usefulness of two-dimensional echocardiographic parameters of the left side of the heart to predict right ventricular failure after left ventricular assist device implantation.
abstract: Right ventricular failure (RVF) after left ventricular assist device (LVAD) placement is associated with increased morbidity and mortality. Echocardiography is a primary imaging method in the assessment of cardiac function; however, visualization of the right-sided heart is often technically difficult in patients with heart failure. We aimed to create a simple and generally applicable scoring system based on "left-sided echocardiographic parameters" to provide complementary information for predicting RVF after LVAD surgery. We reviewed 111 consecutive patients undergoing LVAD surgery from 2007 through 2010. Echocardiograms within 5 days before surgery were analyzed. RVF was defined as an unexpected RV assist devices requirement, nitric oxide inhalation >48 hours, and/or inotropic support >14 days. Thirty-five patients (32%) developed RVF. LV end-diastolic dimension (LVEDD) was smaller, LV ejection fraction was greater, and the left atrial diameter/LVEDD ratio was greater (p < 0.05 for all comparisons) in patients with RVF than in those without RVF. An RVF score (LV echocardiographic RVF score) was determined as a sum of points based on receiver operator characteristics analysis: LVEDD >78, 79 to 70, and <70 mm; LV ejection fraction ≤19%, 19% to 33%, and >33%; and left atrial diameter/LVEDD <0.63, 0.63 to 0.68, and >0.68; each variable was associated with 0 and 1 point and 2 points, respectively. LV echocardiographic RVF score ≥3 was associated with RVF with a sensitivity of 88.6% and score ≥5 with a specificity of 80.3%. In conclusion, patients with relatively small LV size, preserved LV contraction, and dilated left atrium were at higher risk for RVF after LVAD surgery. In conclusion, LV echocardiographic RVF score provides a novel tool to predict RVF after LVAD surgery, which does not involve invasive or technically complicated procedures.
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York, USA. ts2639@columbia.edu
authors.forename: Tomoko Sugiyama
authors.initials: TS
authors.lastname: Kato
authors.forename: Maryjane
authors.initials: M
authors.lastname: Farr
authors.forename: Paul Christian
authors.initials: PC
authors.lastname: Schulze
authors.forename: Mathew
authors.initials: M
authors.lastname: Maurer
authors.forename: Khurram
authors.initials: K
authors.lastname: Shahzad
authors.forename: Shinichi
authors.initials: S
authors.lastname: Iwata
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
authors.forename: Ulrich
authors.initials: U
authors.lastname: Jorde
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.forename: Linda
authors.initials: L
authors.lastname: Gillam
authors.forename: Donna
authors.initials: D
authors.lastname: Mancini
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D018450:Disease Progression; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000628:therapy; D015996:Survival Rate / Q000639:trends; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left