Abstract 2439: Invasive Right Ventricular Hemodynamics and Tricuspid Annular Plane Systolic Excursion to Predict Right Ventricular Dysfunction After Left Ventricular Assist Device Implantation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Elizabeth A Ketner ◽  
Paul R Forfia ◽  
Stuart R Russell ◽  
Ilan S Wittstein ◽  
John V Conte ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Ventricular Assist ◽  
Failure Group ◽  
Group I ◽  
Left Ventricular Assist ◽  
Patients With Heart Failure ◽  
Pulmonary Arterial ◽  
Rv Function

Introduction : Right ventricular (RV) failure is a major cause of morbidity and mortality in heart failure patients undergoing destination left ventricular assist device (LVAD) implantation. Using tricuspid annular plane systolic excursion (TAPSE; an echo based measure of RV function linked to mortality in patients with pulmonary arterial hypertension) and invasive measurement of RV systolic function (dP/dtmax/IP; dP/dt max normalized to instantaneous pressure) we hypothesized that these parameters correlate with the incidence of RV failure post LVAD implantation. Methods : 65 consecutive patients with heart failure and clinical indication for LVAD implantation were prospectively evaluated. All patients underwent transthoracic echocardiography and right heart catheterization within 14 days prior to implantation. TAPSE was measured by M-mode echocardiography as the mean displacement (cm) of the tricuspid annular plane towards the RV apex from end-diastole to end-systole over 3 to 5 cycles. RVFAC was measured as the percent change in RV area from end diastole to end systole as measured in the apical four chamber view. Pressure-dependent measures of RV function were derived from PA catheterization based RV waveforms analyzed using pressure volume loop software (WinPVAN 3.5.8). RV failure post LVAD was defined as IV inotrope therapy requirement >14 days, inhaled NO use >48 hrs, death due to decompensated RV failure, or RVAD implantation. Clinical, hemodynamic and echo data were compared in patients with RV Failure (group I; n=14) vs. those without RV failure (group II; n=51). Results : Groups I and II had similar mean pulmonary arterial pressure, cardiac index, systolic blood pressure, baseline liver function test values, and renal function (P>0.05). Group I had higher right atrial pressure (14±5vs.11±4 mmHg; *p<0.05). TAPSE of less than 1.8 cm and dP/dt max /IP of less than 10 correlated strongly with RV failure post LVAD implantation (P<0.005 and P<0.001, respectively) while RVFAC showed no correlation. Conclusions : TAPSE and the load-independent index dP/dt max/IP correlate strongly with RV failure post-LVAD implantation. These data provide the basis for future study of these endpoints in patients with heart failure and RV dysfunction.

Differences in Clinical Features, Hemodynamic Findings and Clinical Outcomes of Ischemic and Non-ischemic Cardiomyopathy in End-Stage Heart Failure

2021 ◽  
Author(s):  
Zubeyde Bayram ◽  
Süleyman Cagan Efe ◽  
Ali Karagoz ◽  
Cem Dogan ◽  
Busra Guvendi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Ischemic Cardiomyopathy ◽  
Primary Outcome ◽  
Left Ventricular ◽  
Stroke Work ◽  
Ventricular Assist ◽  
Stroke Work Index ◽  
End Stage ◽  
Rv Function

Objectives: The aim of this study was to investigate the effect of heart failure (HF) etiology on clinical, echocardiographic, and hemodynamic findings, right ventricular (RV) function, and outcomes in patients with end-stage HF. Patients and Methods: A total of 470 end-stage HF patients who undergoing evaluation for heart transplantation (HT) were divided into two groups: ischemic cardiomyopathy (ICMP, n=249) and nonischemic cardiomyopathy (NICMP, n=221). RV dysfunction was defined as tricuspid annular plane systolic excursion (TAPSE) ≤1.5 cm (TAPSE-defined RV dysfunction) and right ventricular stroke work index (RVSWI) <5 g/m/beat/m2 (RVSWI-defined RV dysfunction). The primary outcome was defined as left ventricular assist device implantation, urgent HT, or death. Results: Patients with ICMP had higher pulmonary vascular resistance, systolic and mean pulmonary artery pressures (PAPs and PAPm) than those with NICMP [3.0 (1.1-6.0) vs. 2.0 (1.0-5.0),P=0.013; 53.5 (42.0-68.0) vs. 46.0 (32.5-64.5),P <0.001 and 35.512.9 vs. 31.812.3,P=0.002]. RVSWI levels were lower in NICMP patients than in ICMP patients [5.4 (3.7-7.6) vs. 6.5 (4.6-9.6),P <0.001]. While TAPSE-defined RV dysfunction was comparable between NICMP and ICMP, RVSWI-defined RV dysfunction was higher in NICMP (44.3% vs. 55.0%,P=0.069 and 45.2% vs. 31.3%,P=0.012). NICMP was an independent predictor for RVSWI-defined RV dysfunction, but not for TAPSE-defined RV dysfunction, according to multivariate analyses (OR:1.79, 95% CI:1.13-2.82,P=0.012 and OR:0.63, 95% CI:0.28-1.39,P=0.254). Over a median follow-up of 503.5 days, it was demonstrated that HF etiology was not a predictor of primary outcome according to unadjusted and adjusted models (OR:0.99, 95% CI:0.80-1.23,P=0.936 ve OR:0.89, 95% CI:0.60-1.31,P=0.542). Conclusion: We that demonstrated patients with end-stage HF, ICMP had greater RV afterload and RVSWI value than NICMP and HF etiology was not predictor of primary outcome. However, we couldn't say for sure whether HF etiology has an effect on RV function because of the conflicting results in TAPSE-defined RV dysfunction and RVSWI-defined RV dysfunction.

Sign in / Sign up

Export Citation Format

Share Document