Pulmonary Arterial Elastance and INTERMACS-Defined Right Heart Failure Following Left Ventricular Assist Device

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Medical Devices

Background:

• Acute right heart failure (RHF) following left ventricular assist device (LVAD) implantation is a critical issue impacting patient survival.
• Definitions of RHF and predictors of its occurrence pre-LVAD implantation are not well-established.
• This study aimed to clarify these aspects to improve patient outcomes.

Purpose of the Study:

• To evaluate the INTERMACS RHF classification's ability to predict survival post-LVAD implantation.
• To identify preoperative characteristics and hemodynamic parameters that predict severe and severe acute RHF.
• To enhance risk stratification for RHF in LVAD candidates.

Main Methods:

• An international, multicenter study included 375 patients undergoing LVAD implantation with pre-LVAD hemodynamic measurements.
• Right heart failure (RHF) was defined using the INTERMACS criteria.
• Statistical analysis, including multivariable analysis, was performed to identify predictors of RHF and mortality.

Main Results:

• Two-year on-device survival rates were significantly lower in patients with severe-to-severe acute RHF (55%) compared to those with none or mild-to-moderate RHF (71-72%).
• Severe-to-severe acute RHF was independently associated with increased all-cause mortality (HR, 3.95).
• Higher pulmonary arterial elastance (systolic pulmonary artery pressure/stroke volume) and lower INTERMACS classes were significant predictors of severe-to-severe acute RHF.

Conclusions:

• The INTERMACS RHF classification is a valuable tool for predicting mortality risk in LVAD patients, particularly for severe RHF.
• Pulmonary arterial elastance is a strong hemodynamic predictor of severe RHF.
• Combining pulmonary arterial elastance with right atrial pressure may improve the identification of high-risk patients for severe RHF.