Acute Right Ventricular Geometric Change Predicts Outcomes in HeartMate 3 Patients,The Journal of Heart and Lung Transplantation

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Acute Right Ventricular Geometric Change Predicts Outcomes in HeartMate 3 Patients
The Journal of Heart and Lung Transplantation ( IF 8.9 ) Pub Date : 2023-12-07 , DOI: 10.1016/j.healun.2023.11.020
Hideyuki Hayashi , Michael Kirschner , Alice Vinogradsky , Yuming Ning , Paul Kurlansky , Melana Yuzefpolskaya , Paolo C. Colombo , Gabriel T. Sayer , Nir Uriel , Yoshifumi Naka , Koji Takeda

Background

The physiological response of the right ventricle (RV) following left ventricular assist device (LVAD) implantation is difficult to predict. We aimed to investigate RV geometric and functional changes after LVAD insertion and their effects on clinical outcomes.

Methods

We retrospectively reviewed 188 patients who underwent HeartMate 3 implantation at our center between November 2014 and September 2021. The RV end-diastolic diameter (RVEDD) and area (RVEDA) were measured on preoperative and pre-discharge transthoracic echocardiography. The non-adapted group included patients with increased RVEDD and RVEDA at discharge. The composite outcome was defined as death or readmission due to worsening right heart failure.

Results

There were 82 patients (44%) who had a non-adapted and 106 (56%) who had an adapted RV. Preoperatively, the non-adapted group had smaller RVEDD (46 vs. 49 mm, p < 0.001) and RVEDA (27 vs. 31 cm², p < 0.001). At discharge, the non-adapted group had larger RVEDD (51 vs. 43 mm, p < 0.001) and RVEDA (33 vs. 27 cm², p < 0.001). Kaplan-Meier analysis demonstrated worse 3-year survival (77% vs. 91%, p = 0.006) and freedom from composite outcome (58% vs. 85%, p < 0.001) in the non-adapted group. A multivariable Cox proportional hazards model showed that non-adaption (HR 3.09, 95% CI 1.29–7.40 p = 0.01) and age (HR 3.73, 95% CI 1.42–9.77, p = 0.007) were independent predictors of composite outcome.

Conclusions

Acute RV dimensional changes after LVAD insertion may represent intrinsic RV function and may be a useful prognostic marker.

中文翻译：

急性右心室几何变化可预测 HeartMate 3 患者的结果

背景

左心室辅助装置 (LVAD) 植入后右心室 (RV) 的生理反应很难预测。我们的目的是研究 LVAD 插入后 RV 几何和功能的变化及其对临床结果的影响。

方法

我们回顾性分析了 2014 年 11 月至 2021 年 9 月期间在我们中心接受 HeartMate 3 植入的 188 名患者。通过术前和出院前经胸超声心动图测量右心室舒张末期直径 (RVEDD) 和面积 (RVEDA)。未适应组包括出院时 RVEDD 和 RVEDA 增加的患者。复合结果定义为因右心衰竭恶化而死亡或再入院。

结果

有 82 名患者 (44%) 拥有未适应的 RV，106 名患者 (56%) 拥有适应的 RV。术前，非适应组具有较小的 RVEDD（46 vs. 49 mm，p < 0.001）和 RVEDA（27 vs. 31 cm ²，p < 0.001）。出院时，非适应组具有较大的 RVEDD（51 vs. 43 mm，p < 0.001）和 RVEDA（33 vs. 27 cm ²，p < 0.001）。Kaplan-Meier 分析表明，非适应组的 3 年生存率较差（77% vs. 91%，p = 0.006），且无复合结局（58% vs. 85%，p < 0.001）。多变量 Cox 比例风险模型显示，不适应（HR 3.09，95% CI 1.29-7.40 p = 0.01）和年龄（HR 3.73，95% CI 1.42-9.77，p = 0.007）是复合结果的独立预测因子。