title: The incidence, risk factors, and outcomes associated with late right-sided heart failure in patients supported with an axial-flow left ventricular assist device.
abstract: Early right-sided heart failure (RHF) after left ventricular assist device (LVAD) implantation is associated with increased mortality, but little is known about patients who develop late RHF (LRHF). We evaluated the incidence, risk factors, and clinical impact of LRHF in patients supported by axial-flow LVADs.
  
  
  
  Data were analyzed from 537 patients enrolled in the HeartMate II (HM II; Thoratec/St. Jude) destination therapy clinical trial. LRHF was defined as the development of clinical RHF accompanied by the need for inotropic support occurring more than 30 days after discharge from the index LVAD implant hospitalization. Clinical variables, quality of life, rehospitalizations, and survival were compared between patients with and without LRHF.
  
  
  
  LRHF developed in 41 patients (8%), with a median time to LRHF of 480 days. A higher preoperative blood urea nitrogen and increased central venous pressure-to-pulmonary capillary wedge pressure ratio were independent predictors of LRHF. The Michigan and HMII RHF risk scores were both associated with an increased likelihood of LRHF (p < 0.05). Patients with LRHF had worse quality of life according to the Kansas City Cardiomyopathy Questionnaire (61 ± 26 vs 70 ± 21; p < 0.05), poorer functional capacity by 6-minute walk distance (275 ± 189 m vs 312 ± 216 m; p < 0.05), and more rehospitalizations (6 vs 3; p < 0.001). LRHF was associated with decreased survival (p < 0.001).
  
  
  
  LRHF is an important complication in patients with LVADs and is associated with worse quality of life, reduced functional capacity, more frequent hospitalizations, and worse survival compared with those without LRHF.
authors.affiliation: Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois. Electronic address: jonathan.rich@northwestern.edu.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Rich
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts.
authors.forename: Igor
authors.initials: I
authors.lastname: Gosev
authors.affiliation: Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina.
authors.forename: Chetan B
authors.initials: CB
authors.lastname: Patel
authors.affiliation: Division of Cardiology, Department of Medicine, Baylor University, Dallas, Texas.
authors.forename: Susan
authors.initials: S
authors.lastname: Joseph
authors.affiliation: Division of Cardiology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Jason N
authors.initials: JN
authors.lastname: Katz
authors.affiliation: Minneapolis Heart Institute, Minneapolis, Minnesota.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Eckman
authors.affiliation: Spectrum Health, Grand Rapids, Michigan.
authors.forename: Sangjin
authors.initials: S
authors.lastname: Lee
authors.affiliation: Thoratec/St. Jude Medical, St. Paul, Minnesota.
authors.forename: Kartik
authors.initials: K
authors.lastname: Sundareswaran
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Ohio State University, Columbus, Ohio.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Kilic
authors.affiliation: Tenet Healthcare, Delray Beach, Florida.
authors.forename: Brian
authors.initials: B
authors.lastname: Bethea
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Penn State University, State College, Pennsylvania.
authors.forename: Behzad
authors.initials: B
authors.lastname: Soleimani
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Baylor University, Dallas, Texas.
authors.forename: Brian
authors.initials: B
authors.lastname: Lima
authors.affiliation: Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois.
authors.forename: Nir
authors.initials: N
authors.lastname: Uriel
authors.affiliation: Division of Cardiology, Department of Medicine, Tufts University, Boston, Massachusetts.
authors.forename: Michael
authors.initials: M
authors.lastname: Kiernan
mesh_terms: D002423:Cause of Death / Q000639:trends; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*
keywords: HeartMate II; death; late right-sided heart failure; left ventricular assist device; mechanical circulatory support; outcomes; predictors