Propensity Score-Matched Comparison of Right Ventricular Strain in Women and Men Before and After Left Ventricular Assist Device Implantation

Olga N. Kislitsina; Jonathan D. Rich; Jane E. Wilcox; Esther Vorovich; Tingqing Wu; Andrei Churyla; Adin-Christian Andrei; Patrick M. McCarthy; Clyde W. Yancy; Duc Thin Pham

doi:10.1177/15569845221081937

March 1, 2022Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery

Propensity Score-Matched Comparison of Right Ventricular Strain in Women and Men Before and After Left Ventricular Assist Device Implantation

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Why the study?

Adverse events following LVAD implantation are more common in women than in men, but the impact of gender differences on RV failure is not well defined.

Does female gender compared to male gender impact right ventricular strain and failure rates following left ventricular assist device implantation?

Structured PICO

Does female gender compared to male gender impact right ventricular strain and failure rates following left ventricular assist device implantation?

P

Population

172 patients (86 women, 86 men) undergoing left ventricular assist device (LVAD) implantation, propensity score matched 1:1.

I

Intervention

Female gender (observational comparison of women undergoing LVAD implantation)

C

Comparator

Male gender (propensity score matched men undergoing LVAD implantation)

O

Outcome

Right ventricular free wall longitudinal strain (RV-FWS) and fractional area change at 3 months postoperativelysurrogate

Gender differences in adverse outcomes following LVAD implantation do not appear to be driven by differences in right ventricular failure rates as measured by RV strain.

Implication

RV strain recovery similar by sex after LVAD; leaves open other drivers of higher female mortality and TR.

Abstract

Objective: Adverse events following left ventricular assist device (LVAD) implantation are more common in women than in men, but the impact of gender differences on right ventricular (RV) failure is not well defined. Therefore, we calculated RV strain before and after LVAD implantation in matched groups of men and women to determine if gender differences in RV failure after LVAD might account for the gender differences in overall outcomes. Methods: RV free wall longitudinal strain (FWS) and fractional area change were calculated preoperatively and 3 months postoperatively using speckle-tracking echocardiography analysis. A total of 172 patients (86 women, 86 men) were then propensity score matched (1:1) for comparison. Results: Although women had higher preoperative CHA 2 DS 2 -VASc scores and more frequent moderate mitral regurgitation than men ( P = 0.018), the preoperative hemodynamic parameters were similar. Preoperative RV-FWS was −6.7% in women and −6.0% in men ( P = 0.65). Postoperatively, women had more progression to severe tricuspid regurgitation (TR) than men (15% vs 7%, P = 0.06). At 3 months the RV-FWS was −7.7% in women and −7.0% in men ( P = 0.59). Postoperative TR was moderate–severe in 20% of women and in 9% of men ( P = 0.001). Women had a higher incidence of venous thromboembolism, cardiac arrhythmias, and bleeding compared with men. Women also had higher mortality rates at discharge and 30 days after surgery, but the survival rates at 5 years were similar. Conclusions: RV strain measurements track standard hemodynamic and echocardiographic parameters and confirm that gender differences in outcomes following LVAD implantation are not related to gender differences in RV failure rates.