Usefulness of two-dimensional echocardiographic parameters of the left side of the heart to predict right ventricular failure after left ventricular assist device implantation

Tomoko Sugiyama Kato, Maryjane Farr, Paul Christian Schulze, Mathew Maurer, Khurram Shahzad, Shinichi Iwata, Shunichi Homma, Ulrich Jorde, Hiroo Takayama, Yoshifumi Naka, Linda Gillam, Donna Mancini

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Right ventricular failure (RVF) after left ventricular assist device (LVAD) placement is associated with increased morbidity and mortality. Echocardiography is a primary imaging method in the assessment of cardiac function; however, visualization of the right-sided heart is often technically difficult in patients with heart failure. We aimed to create a simple and generally applicable scoring system based on "left-sided echocardiographic parameters" to provide complementary information for predicting RVF after LVAD surgery. We reviewed 111 consecutive patients undergoing LVAD surgery from 2007 through 2010. Echocardiograms within 5 days before surgery were analyzed. RVF was defined as an unexpected RV assist devices requirement, nitric oxide inhalation >48 hours, and/or inotropic support >14 days. Thirty-five patients (32%) developed RVF. LV end-diastolic dimension (LVEDD) was smaller, LV ejection fraction was greater, and the left atrial diameter/LVEDD ratio was greater (p < 0.05 for all comparisons) in patients with RVF than in those without RVF. An RVF score (LV echocardiographic RVF score) was determined as a sum of points based on receiver operator characteristics analysis: LVEDD >78, 79 to 70, and <70 mm; LV ejection fraction ≤19%, 19% to 33%, and >33%; and left atrial diameter/LVEDD <0.63, 0.63 to 0.68, and >0.68; each variable was associated with 0 and 1 point and 2 points, respectively. LV echocardiographic RVF score <3 was associated with RVF with a sensitivity of 88.6% and score <5 with a specificity of 80.3%. In conclusion, patients with relatively small LV size, preserved LV contraction, and dilated left atrium were at higher risk for RVF after LVAD surgery. In conclusion, LV echocardiographic RVF score provides a novel tool to predict RVF after LVAD surgery, which does not involve invasive or technically complicated procedures.

Original languageEnglish (US)
Pages (from-to)246-251
Number of pages6
JournalAmerican Journal of Cardiology
Volume109
Issue number2
DOIs
StatePublished - Jan 15 2012
Externally publishedYes

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Heart-Assist Devices
Heart Atria
Ambulatory Surgical Procedures
Inhalation
Echocardiography
Nitric Oxide
Heart Failure
Morbidity
Equipment and Supplies
Mortality

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Kato, Tomoko Sugiyama ; Farr, Maryjane ; Schulze, Paul Christian ; Maurer, Mathew ; Shahzad, Khurram ; Iwata, Shinichi ; Homma, Shunichi ; Jorde, Ulrich ; Takayama, Hiroo ; Naka, Yoshifumi ; Gillam, Linda ; Mancini, Donna. / Usefulness of two-dimensional echocardiographic parameters of the left side of the heart to predict right ventricular failure after left ventricular assist device implantation. In: American Journal of Cardiology. 2012 ; Vol. 109, No. 2. pp. 246-251.
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abstract = "Right ventricular failure (RVF) after left ventricular assist device (LVAD) placement is associated with increased morbidity and mortality. Echocardiography is a primary imaging method in the assessment of cardiac function; however, visualization of the right-sided heart is often technically difficult in patients with heart failure. We aimed to create a simple and generally applicable scoring system based on {"}left-sided echocardiographic parameters{"} to provide complementary information for predicting RVF after LVAD surgery. We reviewed 111 consecutive patients undergoing LVAD surgery from 2007 through 2010. Echocardiograms within 5 days before surgery were analyzed. RVF was defined as an unexpected RV assist devices requirement, nitric oxide inhalation >48 hours, and/or inotropic support >14 days. Thirty-five patients (32{\%}) developed RVF. LV end-diastolic dimension (LVEDD) was smaller, LV ejection fraction was greater, and the left atrial diameter/LVEDD ratio was greater (p < 0.05 for all comparisons) in patients with RVF than in those without RVF. An RVF score (LV echocardiographic RVF score) was determined as a sum of points based on receiver operator characteristics analysis: LVEDD >78, 79 to 70, and <70 mm; LV ejection fraction ≤19{\%}, 19{\%} to 33{\%}, and >33{\%}; and left atrial diameter/LVEDD <0.63, 0.63 to 0.68, and >0.68; each variable was associated with 0 and 1 point and 2 points, respectively. LV echocardiographic RVF score <3 was associated with RVF with a sensitivity of 88.6{\%} and score <5 with a specificity of 80.3{\%}. In conclusion, patients with relatively small LV size, preserved LV contraction, and dilated left atrium were at higher risk for RVF after LVAD surgery. In conclusion, LV echocardiographic RVF score provides a novel tool to predict RVF after LVAD surgery, which does not involve invasive or technically complicated procedures.",
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Usefulness of two-dimensional echocardiographic parameters of the left side of the heart to predict right ventricular failure after left ventricular assist device implantation. / Kato, Tomoko Sugiyama; Farr, Maryjane; Schulze, Paul Christian; Maurer, Mathew; Shahzad, Khurram; Iwata, Shinichi; Homma, Shunichi; Jorde, Ulrich; Takayama, Hiroo; Naka, Yoshifumi; Gillam, Linda; Mancini, Donna.

In: American Journal of Cardiology, Vol. 109, No. 2, 15.01.2012, p. 246-251.

Research output: Contribution to journalArticle

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AU - Schulze, Paul Christian

AU - Maurer, Mathew

AU - Shahzad, Khurram

AU - Iwata, Shinichi

AU - Homma, Shunichi

AU - Jorde, Ulrich

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AU - Naka, Yoshifumi

AU - Gillam, Linda

AU - Mancini, Donna

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