Increased right-to-left ventricle diameter ratio is a strong predictor of right ventricular failure after left ventricular assist device

Rey P. Vivo, Andrea M. Cordero-Reyes, Umair Qamar, Sireesha Garikipati, Alejandro R. Trevino, Molham Aldeiri, Matthias Loebe, Brian A. Bruckner, Guillermo Torre-Amione, Arvind Bhimaraj, Barry H. Trachtenberg, Jerry D. Estep

Research output: Contribution to journalArticle

51 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)792-799
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume32
Issue number8
DOIs
StatePublished - Aug 1 2013
Externally publishedYes

Keywords

  • echocardiography outcomes
  • left ventricular assist device
  • right ventricular failure
  • risk stratification

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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    Vivo, R. P., Cordero-Reyes, A. M., Qamar, U., Garikipati, S., Trevino, A. R., Aldeiri, M., Loebe, M., Bruckner, B. A., Torre-Amione, G., Bhimaraj, A., Trachtenberg, B. H., & Estep, J. D. (2013). Increased right-to-left ventricle diameter ratio is a strong predictor of right ventricular failure after left ventricular assist device. Journal of Heart and Lung Transplantation, 32(8), 792-799. https://doi.org/10.1016/j.healun.2013.05.016