Predictors of right ventricular failure in patients after left ventricular assist device implantation

Background. To determine predictors of early and late right ventricular failure (RVF) according to transthoracic echocardiography (TTEchoCG) and right heart catheterisation (RHC) in patients with left ventricular assist device (LVAD). Materials and methods. Twenty-three patients with LVAD were included in the study. Before implantation, all patients underwent TTEchoCG with comprehensive evaluation of the right ventricle (RV) using speckle-tracking echocardiography (STE) and 3D-echocardiography (3D-RVEF), as well as RHC with measurement of standard indices and calculation of pulmonary artery pulsatility index (PAPi). Results. The highest area under the ROC curve was the RV ejection fraction determined by 3D-RVEF (0.841 with 95% CI 0.677–1.006, sensitivity 0.889, specificity 0.786; p0.001) with a cut-off value ≤42% (OR 29.3 with 95% CI 2.6–336.4; p=0.007) and PAPi (area on ROC curve 0.869 with 95% CI 0.503–0.975, sensitivity 0.778, specificity 0.857; p0.001,) with a threshold value ≤2.2 (OR 20 with 95% CI 1.2–333.3; p=0.035). The combination of these parameters was the most accurate prognostic model (sensitivity 0.778, specificity 1). The combination of echocardiographic parameters – 3D-RVEF and systolic velocity of the tricuspid valve fibrous ring according to tissue myocardial Doppler (TMD: S’ml) has similar sensitivity (0.778) and slightly lower specificity (0.929). Conclusion. The optimal independent echocardiographic predictor of early RVF is 3D-RVEF. The combination of 3D-RVEF and PAPi proved to be the most accurate model, but the combination of 3D-RVEF and S’ml-TMD echocardiographic parameters alone is only slightly inferior in specificity, which allows preliminary assessment of the risk of RVF.