Assessment of right ventricular dysfunction predictors before the implantation of a left ventricular assist device in end-stage heart failure patients using echocardiographic measures (ARVADE): Combination of left and right ventricular echocardiographic variables

Background. - Right ventricular failure (RVF) is a major cause of morbidity and mortality in left ventricular assist device (LVAD) recipients. Objectives. - To identify preoperative echocardiographic predictors of post-LVAD RVF. Methods. - Data were collected for 42 patients undergoing LVAD implantation in Germany. RVF was defined as the need for placement of a temporary right ventricular assist device or the use of inotropic agents for 14 days. Data for RVF patients were compared with those for patients without RYE A score (ARVADE) was established with independent predictors of RYE by rounding the exponentiated regression model coefficients to the nearest 0.5. Results. - RYE occurred in 24 of 42 LVAD patients. Univariate analysis identified the following measurements as RVF risk factors: basal right ventricular end-diastolic diameter (RVEDD), minimal inferior vena cava diameter, pulsed Doppler transmitral E wave (Em), Em/tissue Doppler lateral systolic velocity (S-LAT) ratio and Em/tissue Doppler septal systolic velocity (S-SEPT) ratio. Em/S-LAT >= 18.5 (relative risk [RR] 2.78, 95% confidence interval [CI] 1.38-5.60; P=0.001), RVEDD >= 50 mm (RR 1.97, 95% CI 1.21-3.20; P=0.008) and INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) level 1 (RR 1.74, 95% CI 1.04-2.91; P=0.04) were independent predictors of RYE An ARVADE score > 3 predicted the occurrence of post-implantation RYE with a sensitivity of 89% and a specificity of 74%. Conclusion. - The ARVADE score, combining one clinical variable and three echocardiographic measurements, is potentially useful for selecting patients for the implantation of an assist device. (C) 2015 Elsevier Masson SAS. All rights reserved.