Ventricular Strain Predicts the Risk of Right Heart Failure After Durable Left Ventricular Assist Device Implantation

Right heart failure (RHF) is prevalent after left ventricular assist device (LVAD) implantation and associated with poor short- and long-term outcomes. The interaction of the right ventricle (RV) with its afterload before LVAD implantation may impact the incidence of RHF.

The aim of the study was to investigate RV pulmonary artery (RVPA) coupling indexes derived from fusing myocardial strain imaging and invasive hemodynamics for their potential to predict RHF or the need for an RV assist device (RVAD).

Patients (N = 288) underwent a retrospective imaging analysis to yield RVPA coupling indexes fused from right ventricle free-wall (RVFW) strain or right ventricle global longitudinal strain (RVGLS) with systolic pulmonary artery pressure (sPAP). Multivariable logistic regression models considering the RVPA indexes and standard hemodynamics were assessed to predict: 1) the need for an RVAD; and 2) RHF.

Eighty-two patients (28.5%) developed RHF, and 52 (18.1%) required a temporary RVAD. Reduced RVFW strain (OR: 1.37; 95% CI: 1.23-1.55; P < 0.001) and RVGLS strain (OR: 1.55; 95% CI: 1.34-1.83; P < 0.001) were associated with the need for an RVAD. RVPA coupling defined by RVFW/sPAP (OR: 0.03^-4; 95% CI: 0.03^-6 to 0.01^-2; P < 0.001) and by RVGLS/sPAP (OR: 0.09^-6; 95% CI: 0.01^-9 to 0.06^-4; P < 0.001) were both associated with the need for an RVAD. The multivariable model with the highest predictive accuracy consisted of RVFW strain and pulmonary artery pulsatility index, yielding an area under the curve of 0.850 with a sensitivity of 88.6% and a specificity of 71.3%.

RVFW strain and coupling indexes derived from catheterization and echocardiographic RV strain imaging can aid with the need for an RVAD and RHF risk stratification following LVAD implantation.