title: Assessment of right ventricular dysfunction predictors before the implantation of a left ventricular assist device in end-stage heart failure patients using echocardiographic measures (ARVADE): Combination of left and right ventricular echocardiographic variables.
abstract: BACKGROUND
  Right ventricular failure (RVF) is a major cause of morbidity and mortality in left ventricular assist device (LVAD) recipients.
  
  
  OBJECTIVE
  To identify preoperative echocardiographic predictors of post-LVAD RVF.
  
  
  METHODS
  Data were collected for 42 patients undergoing LVAD implantation in Germany. RVF was defined as the need for placement of a temporary right ventricular assist device or the use of inotropic agents for 14 days. Data for RVF patients were compared with those for patients without RVF. A score (ARVADE) was established with independent predictors of RVF by rounding the exponentiated regression model coefficients to the nearest 0.5.
  
  
  RESULTS
  RVF occurred in 24 of 42 LVAD patients. Univariate analysis identified the following measurements as RVF risk factors: basal right ventricular end-diastolic diameter (RVEDD), minimal inferior vena cava diameter, pulsed Doppler transmitral E wave (Em), Em/tissue Doppler lateral systolic velocity (SLAT) ratio and Em/tissue Doppler septal systolic velocity (SSEPT) ratio. Em/SLAT≥18.5 (relative risk [RR] 2.78, 95% confidence interval [CI] 1.38-5.60; P=0.001), RVEDD≥50 mm (RR 1.97, 95% CI 1.21-3.20; P=0.008) and INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) level 1 (RR 1.74, 95% CI 1.04-2.91; P=0.04) were independent predictors of RVF. An ARVADE score>3 predicted the occurrence of post-implantation RVF with a sensitivity of 89% and a specificity of 74%.
  
  
  CONCLUSIONS
  The ARVADE score, combining one clinical variable and three echocardiographic measurements, is potentially useful for selecting patients for the implantation of an assist device.
authors: Georges-Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France; Heart and Diabetes Centre, NRW, Bad Oeynhausen, Germany; Faculty of Medicine, University Paris Descartes, Paris, France; INSERM U 678, University Paris VI, Paris, France. Electronic address: nadia.aissaoui@egp.aphp.fr.
authors: Nadia
authors: N
authors: Aissaoui
authors: Georges-Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.
authors: Joe-Elie
authors: JE
authors: Salem
authors: Heart and Diabetes Centre, NRW, Bad Oeynhausen, Germany.
authors: Lech
authors: L
authors: Paluszkiewicz
authors: Heart and Diabetes Centre, NRW, Bad Oeynhausen, Germany.
authors: Michiel
authors: M
authors: Morshuis
authors: Georges-Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.
authors: Emmanuel
authors: E
authors: Guerot
authors: Heart and Diabetes Centre, NRW, Bad Oeynhausen, Germany.
authors: Gonzalo Martin
authors: GM
authors: Gorria
authors: Georges-Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France; INSERM U 678, University Paris VI, Paris, France.
authors: Jean-Yves
authors: JY
authors: Fagon
authors: Heart and Diabetes Centre, NRW, Bad Oeynhausen, Germany.
authors: Jan
authors: J
authors: Gummert
authors: Georges-Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France; Faculty of Medicine, University Paris Descartes, Paris, France; INSERM U 678, University Paris VI, Paris, France.
authors: Benoit
authors: B
authors: Diebold
mesh_terms: D000328:Adult; D000368:Aged; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology*; D016278:Ventricular Function, Right / Q000502:physiology*
keywords: Assist device; Assistance ventriculaire; Doppler tissue velocities; Doppler tissulaire; Echocardiography; INTERMACS level; Insuffisance ventriculaire droite; Niveau INTERMACS; Right ventricular failure; Échocardiographie