The Right Ventricular Failure Risk Score
Key result
RVFRS ≥5.5 is linked to a ~7-fold higher risk of post-operative RV failure.
- OR 7.6
- 95% CI 3.4-17.1
- n=197
Why the study?
Does the Right Ventricular Failure Risk Score (RVFRS) predict post-operative right ventricular failure in LVAD candidates?
Population
197 left ventricular assist device (LVAD) candidates
Comparison
Right Ventricular Failure Risk Score composed of… vs Other commonly used predictors of RV failure
Design
Cohort
Follow-up
180 days
Authors
Discussion
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Implication
The RVFRS, using routine pre-operative clinical data, effectively stratifies the risk of right ventricular failure and death after LVAD implantation.
Key Points
- To establish and validate a pre-operative clinical risk score capable of predicting post-operative right ventricular failure in candidates for left ventricular assist device placement.
- Evaluated a prospectively maintained database of 197 consecutive patients undergoing left ventricular assist device (LVAD) implantation for pre-operative clinical, laboratory, echocardiographic, and hemodynamic variables.
- Defined right ventricular failure as requiring post-operative intravenous inotropes for >14 days, inhaled nitric oxide for ≥48 hours, right-sided mechanical support, or hospital discharge on an inotrope.
- Developed the Right Ventricular Failure Risk Score (RVFRS) using multivariable logistic regression coefficients and evaluated discriminatory performance with receiver-operating characteristic curve analysis.
- Post-operative right ventricular failure occurred in 68 of 197 patients (35%), with independent predictors identified as vasopressor need (4 points), AST ≥80 IU/l (2 points), bilirubin ≥2.0 mg/dl (2.5 points), and creatinine ≥2.3 mg/dl (3 points).
- Right ventricular failure risk escalated across risk strata, with odds ratios of 0.49 (95% CI: 0.37–0.64) for RVFRS ≤3.0, 2.8 (95% CI: 1.4–5.9) for RVFRS 4.0–5.0, and 7.6 (95% CI: 3.4–17.1) for RVFRS ≥5.5.
- The RVFRS demonstrated an area under the receiver-operating characteristic curve of 0.73 ± 0.04 (p < 0.05 versus traditional predictors), alongside decreasing 180-day survival rates of 90 ± 3%, 80 ± 8%, and 66 ± 9% across low-, intermediate-, and high-risk tiers (p = 0.0045).
Study Design
Type
Observational (n=197)
Structured PICO
Does the Right Ventricular Failure Risk Score (RVFRS) predict post-operative right ventricular failure in LVAD candidates?
P
Population
197 left ventricular assist device (LVAD) candidates evaluated for pre-operative predictors of post-operative right ventricular failure.
E
Exposure
Right Ventricular Failure Risk Score (RVFRS) composed of pre-operative clinical data (vasopressor requirement, AST >=80 IU/l, bilirubin >=2.0 mg/dl, and creatinine >=2.3 mg/dl)
C
Comparator
Other commonly used predictors of RV failure
O
Outcome
Right ventricular failure (defined as need for post-operative intravenous inotrope support for >14 days, inhaled nitric oxide for >=48 h, right-sided circulatory support, or hospital discharge on an inotrope)composite
Main Result
Odds Ratio: 7.6 (95% CI 3.4–17.1)
The RVFRS, using routine pre-operative clinical data, effectively stratifies the risk of right ventricular failure and death after LVAD implantation.
Cite This Study
Koelling et al. (2008) conducted an observational in Left ventricular assist device (LVAD) candidates (n=197). Right Ventricular Failure Risk Score (RVFRS) ≥5.5 vs. Lower RVFRS scores was evaluated on Right ventricular failure (OR 7.6, 95% CI 3.4-17.1). A Right Ventricular Failure Risk Score (RVFRS) ≥5.5 was strongly associated with post-operative right ventricular failure (OR 7.6; 95% CI 3.4-17.1) and reduced 180-day survival.