Hemodynamic reserve predicts early right heart failure after LVAD implantation

Jacob M. Read, Nnamdi I. Azih, Carli J. Peters, Vikram Gurtu, Julie K. Vishram-Nielsen, Stephen P. Wright, Ana Carolina Alba, Mathew J. Gregoski, Nicole A. Pilch, Steven Hsu, Michael V. Genuardi, Chakradhari Inampudi, Gregory R. Jackson, Nicholas Pope, Lucas P. Witer, Arman Kilic, Brian A. Houston, Susanna Mak, Edo Y. Birati, Ryan J. Tedford

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Background: Early right heart failure (RHF) remains a major source of morbidity and mortality after left ventricular assist device (LVAD) implantation, yet efforts to predict early RHF have proven only modestly successful. Pharmacologic unloading of the left ventricle may be a risk stratification approach allowing for assessment of right ventricular and hemodynamic reserve. Methods: We performed a multicenter, retrospective analysis of patients who had undergone continuous-flow LVAD implantation from October 2011 to April 2020. Only those who underwent vasodilator testing with nitroprusside during their preimplant right heart catheterization were included (n = 70). Multivariable logistic regression was used to determine independent predictors of early RHF as defined by Mechanical Circulatory Support–Academic Research Consortium. Results: Twenty-seven patients experienced post-LVAD early RHF (39%). Baseline clinical characteristics were similar between patients with and without RHF. Patients without RHF, however, achieved higher peak stroke volume index (SVI) (30.1 ± 8.8 vs 21.7 ± 7.4 mL/m2; p < 0.001; AUC: 0.78; optimal cut-point: 22.1 mL/m2) during nitroprusside administration. Multivariable analysis revealed that peak SVI was significantly associated with early RHF, demonstrating a 16% increase in risk of early RHF per 1 ml/m2 decrease in SVI. A follow up cohort of 10 consecutive patients from July 2020 to October 2021 resulted in all patients being categorized appropriately in regards to early RHF versus no RHF according to peak SVI. Conclusion: Peak SVI with nitroprusside administration was independently associated with post-LVAD early RHF while resting hemodynamics were not. Vasodilator testing may prove to be a strong risk stratification tool when assessing LVAD candidacy though additional prospective validation is needed.

Original languageEnglish
Pages (from-to)1716-1726
Number of pages11
JournalJournal of Heart and Lung Transplantation
Volume41
Issue number12
DOIs
StatePublished - Dec 2022

Bibliographical note

Publisher Copyright:
© 2022 International Society for Heart and Lung Transplantation

Funding

All authors report no direct conflicts of interest related to this manuscript. Dr. Tedford reports general disclosures to include consulting relationships with Medtronic, Abbott, Aria CV Inc., Arena Pharmaceuticals, Acceleron, Itamar, Edwards LifeSciences, Eidos Therapeutics, Lexicon Pharmaceuticals, Gradient and United Therapeutics. Dr. Tedford is on a steering committee for Acceleron and Abbott as well as a research advisory board for Abiomed. He also does hemodynamic core lab work for Actelion and Merck. Dr. Birati reports general disclosures to include research support paid to the University of Pennsylvania by Impulse Dynamics and Medtronic Inc. Dr. Houston reports general disclosures to include consulting relationships with Medtronic and Bioventrix. He has received research grant funding from Medtronic. Dr. Jackson reports general disclosures to include speaking honorarium from Respicardia, Inc. Dr. Inampudi reports general disclosures to include consulting relationship with Abbott. Dr. Kilic reports general disclosures to include consulting relationship with Abiomed and medical advisor board for Medtronic Inc. Dr. Genuardi reports general disclosures to include consulting relationship with Respicardia, and non-financial compensation from Abbott.

FundersFunder number
Medtronic

    Keywords

    • hemodynamics
    • left ventricular assist device
    • pulmonary hypertension
    • stroke volume index
    • ventricular reserve

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