Are right ventricular risk scores useful?

Left ventricular assist device (LVAD) implantation can be complicated by right ventricular (RV) failure. Several scores have been proposed to predict this event. Our aim was to validate three of these scores in a population which had received a rotary blood pump LVAD.

In a consecutive series of 59 full LVAD implantations, preoperative clinical, echocardiographic, laboratory and haemodynamic values were retrospectively collected. Three previously published predictive scores were calculated for all the patients. A logistic regression analysis was used to identify the predictors of RV support after LVAD implantation.

Fourteen patients (23.7%) needed additional temporary RV support. The three scores did not present any significant difference between patients treated with LVAD plus right ventricular assist device or LVAD only (45.86 ± 14.02 vs 42.1 ± 17.34, P = 0.46; 4.57 ± 3.37 vs 4.94 ± 2.87, P = 0.69; 2.71 ± 2.11 vs 2.92 ± 2.99m P = 0.81) and they were not predictive for RV failure. High pulmonary vascular resistance and the presence of non-ischaemic cardiomyopathy were the only significant predictors in logistic regression.

The use of risk scores failed to predict the need of RV support after LVAD. Stratification of the hazard with these scores should occur with extreme caution.