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A novel metrics to predict right heart failure after left ventricular assist device implantation

  • Original Article
  • Artificial Heart (Clinical)
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Abstract

Background

Right Heart Failure (RHF) is a severe complication that can occur after left ventricular assist device (LVAD) implantation, increasing early and late mortality. Although numerous RHF predictive scores have been developed, limited data exist on the external validation of these models. We therefore aimed at comparing existent risk score models and identifying predictors of severe RHF at our center.

Methods

In this retrospective, single-center analysis, clinical, biological and functional data were collected in patients implanted with a LVAD between 2011 and 2020. Early severe RHF was defined as the use of inotropes for ≥ 14 days, nitric oxide use for ≥ 48 h or unplanned right-sided circulatory support. Risk models were evaluated for the primary outcome of RHF or RVAD implantation by means of logistic regression and receiver operating characteristic curves.

Results

Among 92 patients implanted, 24 (26%) developed early severe RHF. The EUROMACS-RHF risk score performed the best in predicting RHF (C = 0.82–95% CI: 0.68–0.90), compared with the other scores (Michigan, CRITT).

In addition, we developed a new model, based on four variables selected for the best reduced logistic model: the INTERMACS level, the number of inotropes used, the ratio of right atrial/pulmonary capillary wedge pressure and the ratio of right ventricle/left ventricle diameters by echocardiography. This model demonstrated significant discrimination of RHF (C = 0.9–95% CI: 0.76–0.96).

Conclusion

Amongst available risk scores, EUROMACS-RHF performs best to predict the occurrence of RHF after LVAD implantation. Our model’s performance compares well to the EUROMACS-RHF score, adding a more objective parameter to RV function evaluation.

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Acknowledgements

AR had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. FV and AR designed the study, interpreted data and drafted the manuscript. FV collected and analyzed data. EE performed the statistical analysis. CS, JLV, CD, EE, FVE have made substantial contributions to the conception and design and interpretation of data, and revised the article critically for important intellectual content. All authors have provided final approval of the version to be published.

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Authors and Affiliations

  1. Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, 808 Route de Lennik, 1070, Brussels, Belgium

    Federica Valente, Jean-Luc Vachiéry, Céline Dewachter & Ana Roussoulières

  2. Department of Cardiac Surgery, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium

    Constantin Stefanidis & Frédéric Vanden Eynden

  3. EW Data Analysis, Brussels, Belgium

    Edgard Engelman

Authors
  1. Federica Valente
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  2. Constantin Stefanidis
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  5. Edgard Engelman
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  6. Frédéric Vanden Eynden
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  7. Ana Roussoulières
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Contributions

Conceptualization: FV, CS, JL V, CD, AR. Data curation: FV, EE. Formal analysis: EE. Investigation: FV, CS, AR. Methodology: FV, AR. Project administration: AR. Resources: CS, AR. Supervision: CS, J-LV, CD, AR. Writing-original draft: FV, AR. Writing-review and editing: CS, J-LV, CD, EE, FVE, AR.

Corresponding author

Correspondence to Federica Valente.

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Conflict of interest

Dr. Valente reports no direct conflicts of interest relevant to this manuscript. Dr. Stefanidis reports no direct conflicts of interest relevant to this manuscript. Dr. Vachiéry reports no direct conflicts of interest relevant to this manuscript. Dr. Dewachter reports no direct conflicts of interest relevant to this manuscript. Dr. Engelman reports no direct conflicts of interest relevant to this manuscript. Dr. Vanden Eyden reports no direct conflicts of interest relevant to this manuscript. Dr. Roussoulières reports no direct conflicts of interest relevant to this manuscript.

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Valente, F., Stefanidis, C., Vachiéry, JL. et al. A novel metrics to predict right heart failure after left ventricular assist device implantation. J Artif Organs 26, 24–35 (2023). https://doi.org/10.1007/s10047-022-01334-3

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  • DOI: https://doi.org/10.1007/s10047-022-01334-3

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