Hemodynamic reserve predicts early right heart failure after LVAD implantation
Section snippets
Methods
After IRB approval, we performed a multicenter retrospective analysis of patients who had undergone continuous-flow LVAD implantation from October 2011 to April 2020. The three centers included were the Medical University of South Carolina (2016-2020), the University of Pennsylvania (2017-2020) and the University Health Network in Toronto (2011-2020). Only patients who underwent clinically indicated vasodilator testing with nitroprusside within one year of LVAD implant as part of their advanced
Results
Of the 70 patients included, 27 patients developed early RHF (39%) after LVAD implantation, including 14 patients who required right ventricular assist device (RVAD) support (20%). The mean age of the cohort was 49 ± 14 years with the majority of patients being men (77%) and with nonischemic cardiomyopathy (74%). Early RHF differed by centers, device type, and time between RHC and LVAD implant. There were no other significant difference in demographics, preimplant clinical characteristics, RHF
Discussion
The major findings of our study can be summarized as follows: (1) Early postimplant RHF was common in our cohort, (2) baseline clinical characteristics, echocardiographic and hemodynamic measures were not strongly and independently predictive of early RHF, and (3) hemodynamics at the peak of nitroprusside vasodilator administration, particularly peak SVI, was a good discriminator of those who did and did not develop early postimplant RHF. These findings suggest that vasodilator testing and
Conclusions
In summary, peak SVI during nitroprusside infusion was significantly associated with post-LVAD early RHF. These findings suggest vasodilator testing and acute pharmacologic LV unloading may be useful in risk stratification prior to LVAD implantation in patients with elevated pulmonary pressures and should be prospectively studied.
Author contributions
Jacob M. Read, MD: Study Conception/Design, Data Acquisition, Data Analysis, Data Interpretation, Drafting of manuscript, Final approval of manuscript. Nnamdi I. Azih, MD: Study Conception/Design, Data Acquisition, Data Analysis, Data Interpretation, Drafting of manuscript, Final approval of manuscript. Carli J. Peters, MD: Data Acquisition, Data Analysis, Critical revision of manuscript, Final approval of manuscript. Vikram Gurtu, MD: Data Acquisition, Data Analysis, Critical revision of
Disclosures
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
Financial disclosures
No grants, contracts, or other financial support was received for this manuscript.
Acknowledgments
We wish to acknowledge our mechanical circulatory support teams who help us care for this complex patient population.
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