title: Increased right-to-left ventricle diameter ratio is a strong predictor of right ventricular failure after left ventricular assist device.
abstract: BACKGROUND
  Predictors of right ventricular failure (RVF) in patients with left ventricular assist devices (LVADs) have not been fully elucidated and are comprised mostly of clinical variables. We evaluated echocardiographic parameters associated with adverse outcomes in this population.
  
  
  METHODS
  Transthoracic echocardiograms (TTEs) before continuous-flow LVAD implantation were analyzed in 109 patients. Twenty-six 2-dimensional and Doppler parameters were assessed for their association with the primary outcome of 30-day RVF, defined as a requirement of an RV assist device or ≥ 14 consecutive days of inotropic support, and the secondary composite outcome of 30-day death or RVF. Multivariate analysis adjusted for known clinical risk prediction models was performed.
  
  
  RESULTS
  Overall, 25 (22.9%) and 27 (24.8%) patients reached the primary and secondary end-points, respectively. An increased RV/LV diameter ratio was the only TTE variable independently associated with both the primary (odds ratio [OR] = 5.40; 95% confidence interval [CI] 2.40 to 12.40; p = 0.012) and secondary (OR = 2.70; 95% CI 1.06 to 6.22; p = 0.03) outcomes after multivariate analysis. Scatterplot analysis with regression determined the optimal cut-off value for RV/LV diameter to be 0.75. Based on receiver operating characteristic curves, an increased RV/LV diameter ratio provided an additional predictive value to clinical risk scores.
  
  
  CONCLUSIONS
  A TTE-measured RV/LV diameter ratio of ≥0.75 is independently associated with a higher risk for RVF in patients with continuous-flow LVAD. When used alone, this simple, easily derived, practical echocardiographic measurement has a predictive value equivalent to known clinical risk scores, whereas their combination provides stronger risk prediction for adverse outcomes.
authors.affiliation: Department of Cardiology, Section of Heart Failure and Heart Transplantation, Houston, Texas 77030, USA,
authors.forename: Rey P
authors.initials: RP
authors.lastname: Vivo
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Cordero-Reyes
authors.forename: Umair
authors.initials: U
authors.lastname: Qamar
authors.forename: Sireesha
authors.initials: S
authors.lastname: Garikipati
authors.forename: Alejandro R
authors.initials: AR
authors.lastname: Trevino
authors.forename: Molham
authors.initials: M
authors.lastname: Aldeiri
authors.forename: Matthias
authors.initials: M
authors.lastname: Loebe
authors.forename: Brian A
authors.initials: BA
authors.lastname: Bruckner
authors.forename: Guillermo
authors.initials: G
authors.lastname: Torre-Amione
authors.forename: Arvind
authors.initials: A
authors.lastname: Bhimaraj
authors.forename: Barry H
authors.initials: BH
authors.lastname: Trachtenberg
authors.forename: Jerry D
authors.initials: JD
authors.lastname: Estep
mesh_terms: D005260:Female; D006333:Heart Failure / Q000601:surgery*; D006352:Heart Ventricles / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D014463:Ultrasonography; D018497:Ventricular Dysfunction, Right / Q000209:etiology*
keywords: echocardiography; left ventricular assist device; outcomes; right ventricular failure; risk stratification