Right Atrial Pressure/Pulmonary Capillary Wedge Pressure Ratio Predicts In-Hospital Mortality in Left Ventricular...

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Medical Devices

Background:

• Right ventricular failure (RVF) is a critical factor in early mortality post-left ventricular assist device (LVAD) implantation.
• Predictive markers for RVF and right ventriculoarterial coupling require further investigation for in-hospital mortality risk stratification.
• The right atrial pressure/pulmonary capillary wedge pressure (RAP/PCWP) ratio serves as a surrogate for right ventriculoarterial coupling.

Purpose of the Study:

• To evaluate the prognostic significance of the preoperative RAP/PCWP ratio in predicting in-hospital mortality after LVAD implantation.
• To determine the optimal cut-off value of the RAP/PCWP ratio for risk stratification.

Main Methods:

• Retrospective analysis of 44 patients undergoing LVAD implantation.
• Collection of preoperative clinical, echocardiographic, and hemodynamic data.
• Receiver operating characteristic (ROC) analysis to identify the optimal RAP/PCWP ratio cut-off.
• Univariate and multivariate logistic regression to assess predictors of in-hospital mortality.

Main Results:

• A RAP/PCWP ratio cut-off of 0.47 was identified (AUC: 0.829).
• Patients with a high RAP/PCWP ratio (≥0.47) exhibited significantly higher in-hospital mortality (46% vs. 10%, p=0.020).
• The RAP/PCWP ratio (OR: 3.48 per 0.1 increase) and INTERMACS 1-2 profile (OR: 39.19) were independent predictors of in-hospital mortality.

Conclusions:

• The preoperative RAP/PCWP ratio is an independent predictor of in-hospital mortality following LVAD implantation.
• This ratio serves as a valuable surrogate marker for right ventriculoarterial coupling.
• Integrating the RAP/PCWP ratio into preoperative assessments can improve risk stratification and guide management for LVAD candidates.