Validation of the Hemodynamic Classification System for Hemodynamic‐Related Events in Patients With Durable Left Ventricular Assist Devices

Figures

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  Figure 1. Study population flowchart. HDRE indicates hemodynamic‐related event; and LVAD, left ventricular assist device.

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  Figure 2. HDREs incidence, intensity, and phenotypes at 6‐month post‐dLVAD assessment in the study cohort. Rates are surrounded by their 95% CIs. AI indicates aortic insufficiency; dLVAD, durable left ventricular assist device; HDRE, hemodynamic‐related event; and RHF, right heart failure.

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  Figure 3. Selection of relevant clinical and instrumental characteristics at different time points stratified by HDRE phenotypes. The HDRE phenotypes identified by the Hemodynamic Classification System correspond to relevant pathophysiological clusters, present with specific clinical, echocardiographic, and hemodynamic patterns, and are associated with functional capacity. Optimal echocardiographic profile denotes the presence of neutral interventricular septal position, mitral regurgitation less than moderate and (at least intermittent) aortic valve opening, as proposed by the International Society for Heart and Lung Transplantation guidelines. 21 The optimal hemodynamic profile denotes the presence of a cardiac index ≥2.2 L/min per m2, wedge pressure <18 mm Hg, and right atrial pressure <12 mm Hg assessed at right heart catheterization, as previously proposed and validated. 19 , 20 AI indicates aortic insufficiency; AVR, aortic valve replacement; HDRE, hemodynamic‐related event; LVAD, left ventricular assist device; PAPi, pulmonary artery pulsatility index; RAP, right atrial pressure; RHF, right heart failure; and TR, tricuspid regurgitation.

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  Figure 4. Association of HDREs with the primary outcome. AI HDRE and RHF HDRE at 6 months after dLVAD implant are independently associated with HF hospitalization of cardiovascular death at 2.5 years after dLVAD implant. AI indicates aortic insufficiency; HDRE, hemodynamic‐related event; HR, hazard ratio; and RHF, right heart failure.

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  Figure 5. HDRE phenotypes and their association with the primary outcome. The HDRE phenotypes identified by the Hemodynamic Classification System correspond to relevant pathophysiological clusters, present with specific clinical, echocardiographic, and hemodynamic patterns, and provide incremental prognostic value. The HDRE phenotype could not be adjudicated in 3 (4.4%) patients. AI indicates aortic insufficiency; CI, cardiac index; HDRE, hemodynamic‐related event; PAWP, pulmonary artery wedge pressure; RAP, right atrial pressure; and RHF, right heart failure.