Ventricular Strain Predicts the Risk of Right Heart Failure After Durable Left Ventricular Assist Device Implantation

Q: What are the key findings of this study?

Reduced preoperative right ventricular free-wall strain was significantly associated with an increased need for a right ventricular assist device following LVAD implantation (OR 1.37).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Patients undergoing left ventricular assist device (LVAD) implantation (n=288). Intervention: Right ventricular free-wall (RVFW) strain and pulmonary artery pulsatility index (PAPi). Primary outcome: Unplanned need for a right ventricular assist device (RVAD) (OR 1.37, 95% CI 1.23-1.55, p=<0.001).

Q: What does this research mean for the field?

Reduced preoperative right ventricular free-wall strain is significantly associated with an increased need for a right ventricular assist device and right heart failure following left ventricular assist device implantation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate whether right ventricular pulmonary artery coupling indexes derived from myocardial strain imaging and invasive hemodynamics predict right heart failure or the need for a right ventricular assist device after left ventricular assist device implantation.

Michal Schäfer; Syed Shahyan Bakhtiyar; Thomas C. Hanff; Spencer Carter; Satvik Ramakrishna; Ethan Tumarkin; Matthew L. Goodwin; Hiroshi Kagawa; Bryce Hill; Andrew Scott; Stavros George Drakos; Josef Stehlik; Craig H. Selzman

doi:10.1016/j.jacadv.2026.103240

September 17, 2026JACC AdvancesOpen Access

Ventricular Strain Predicts the Risk of Right Heart Failure After Durable Left Ventricular Assist Device Implantation

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Key result

Reduced preoperative RV free-wall strain is linked to ~37% higher odds of post-LVAD RVAD need.

OR 1.37
95% CI 1.23-1.55
P<0.001
n=288

Figures

Graphical abstract published by JACC Advances — Graphical abstract · Published by JACC Advances · CC BY

Why the study?

Right heart failure is prevalent after LVAD implantation and the impact of right ventricle-pulmonary artery coupling on predicting RHF or RVAD need was unclear.

Do preoperative right ventricular strain and right ventricular pulmonary artery (RVPA) coupling indexes predict the risk of right heart failure and the need for a right ventricular assist device following LVAD implantation?

Key Points

To evaluate whether right ventricular pulmonary artery coupling indexes derived from myocardial strain imaging and invasive hemodynamics predict right heart failure or the need for a right ventricular assist device after left ventricular assist device implantation.
Retrospective imaging and hemodynamic analysis of N=288 patients who underwent durable left ventricular assist device implantation between January 2015 and April 2024.
Right ventricular pulmonary artery coupling indexes were derived by combining right ventricle free-wall strain or right ventricle global longitudinal strain with systolic pulmonary artery pressure.
Univariable and multivariable logistic regression models combining echocardiographic strain and catheterization parameters were evaluated using receiver operating characteristic curve analysis.
Right heart failure developed in 82 of 288 patients (28.5%), and 52 of 288 patients (18.1%) required a temporary right ventricular assist device.
Reduced right ventricular free-wall strain (OR: 1.37; 95% CI: 1.23-1.55; P < 0.001) and right ventricular global longitudinal strain (OR: 1.55; 95% CI: 1.34-1.83; P < 0.001) were significantly associated with the need for a right ventricular assist device.
A multivariable model combining right ventricular free-wall strain and pulmonary artery pulsatility index yielded an area under the curve of 0.850 (sensitivity 88.6%, specificity 71.3%) for predicting right ventricular assist device need, and an area under the curve of 0.787 (sensitivity 84.1%, specificity 62.1%) for right heart failure.

Study Design

Type

Cohort (n=288)

Multicenter

No

Structured PICO

Do preoperative right ventricular strain and right ventricular pulmonary artery (RVPA) coupling indexes predict the risk of right heart failure and the need for a right ventricular assist device following LVAD implantation?

P

Population

288 adults (mean age 56, 16% female) undergoing LVAD implantation evaluated for pre-operative right ventricular echocardiographic strain and hemodynamic markers.

E

Exposure

Preoperative measurement of right ventricular free-wall (RVFW) strain via transthoracic echocardiography and right heart catheterization hemodynamics (PAPi).

O

Outcome

1) Unplanned need for a right ventricular assist device (RVAD) within 30 days postoperatively, and 2) Right heart failure (RHF) defined as requiring inotropic therapy >14 days or inhaled nitric oxide >48 hours.hard clinical

Main Result

Odds Ratio: 1.37 (95% CI 1.23–1.55)

p-value: p=<0.001

Limitations

Retrospective single-institution design
Requires external validation
Covered a 10-year period with different MCS devices and varying treatment strategies
Omitted comparisons with other established RHF risk models
10-year period covered different types of MCS devices and intraoperative/postoperative strategies
Omitted comparisons with other known RHF risk models

Implication

Combining echocardiographic right ventricular free-wall strain with invasive right heart catheterization hemodynamics significantly improves preoperative risk stratification for right heart failure and RVAD need in patients undergoing LVAD implantation.

Abstract

BACKGROUND: Right heart failure (RHF) is prevalent after left ventricular assist device (LVAD) implantation and associated with poor short- and long-term outcomes. The interaction of the right ventricle (RV) with its afterload before LVAD implantation may impact the incidence of RHF. OBJECTIVES: The aim of the study was to investigate RV pulmonary artery (RVPA) coupling indexes derived from fusing myocardial strain imaging and invasive hemodynamics for their potential to predict RHF or the need for an RV assist device (RVAD). METHODS: Patients (N = 288) underwent a retrospective imaging analysis to yield RVPA coupling indexes fused from right ventricle free-wall (RVFW) strain or right ventricle global longitudinal strain (RVGLS) with systolic pulmonary artery pressure (sPAP). Multivariable logistic regression models considering the RVPA indexes and standard hemodynamics were assessed to predict: 1) the need for an RVAD; and 2) RHF. RESULTS: ; P < 0.001) were both associated with the need for an RVAD. The multivariable model with the highest predictive accuracy consisted of RVFW strain and pulmonary artery pulsatility index, yielding an area under the curve of 0.850 with a sensitivity of 88.6% and a specificity of 71.3%. CONCLUSIONS: RVFW strain and coupling indexes derived from catheterization and echocardiographic RV strain imaging can aid with the need for an RVAD and RHF risk stratification following LVAD implantation.

Discussion

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Cite This Study

Schäfer et al. (2026) conducted a cohort in Patients undergoing left ventricular assist device (LVAD) implantation (n=288). Right ventricular free-wall (RVFW) strain and pulmonary artery pulsatility index (PAPi) was evaluated on Unplanned need for a right ventricular assist device (RVAD) (OR 1.37, 95% CI 1.23-1.55, p=<0.001). Reduced preoperative right ventricular free-wall strain was significantly associated with an increased need for a right ventricular assist device following LVAD implantation (OR 1.37).

synapsesocial.com/papers/6ad0fd3315427f6a8404058c https://doi.org/10.1016/j.jacadv.2026.103240

Topics

Heart failure

HFrEF treatment

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Ventricular Strain Predicts the Risk of Right Heart Failure After Durable Left Ventricular Assist Device Implantation

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Ventricular Strain Predicts the Risk of Right Heart Failure After Durable Left Ventricular Assist Device Implantation

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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