Usefulness of right ventricular contraction pressure index to predict short-term mortality and right heart failure in patients who underwent continuous-flow left ventricular assist device implantation

• Published in: International journal of artificial organs Vol. 43; no. 1; pp. 25 - 36
• Main Authors: Kalenderoğlu, Koray, Güvenç, Tolga Sinan, Mete, Müge Taşdemir, Kuplay, Hüseyin, Ağustos, Semra, Güzelburç, Özge Çalbayram, Yıldırımtürk, Özlem, Kozan, Ömer, Aka, Serap Aykut
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-01-2020; Wichtig Editore s.r.l
• Subjects: Capillary pressure; Confidence intervals; Congestive heart failure; Continuous flow; Correlation analysis; Demographics; Echocardiography; Female; Health risk assessment; Heart failure; Heart Failure - mortality; Heart Failure - physiopathology; Heart-Assist Devices; Humans; Implantation; Male; Middle Aged; Mortality; Myocardial Contraction - physiology; Parameters; Pilot Projects; Pressure; Pulmonary Wedge Pressure - physiology; Quartiles; Registries; Retrospective Studies; Short term; Statistical analysis; Statistical models; Stroke; Stroke Volume - physiology; Survival; Time Factors; Vascular Resistance - physiology; Ventricle; Ventricular Dysfunction, Right - physiopathology; Heart failure; right ventricular contraction pressure index; left ventricular assist device; right ventricular stroke work index; echocardiography
• ISSN: 0391-3988; 1724-6040
• DOI: 10.1177/0391398819868480

Background:
Right ventricular stroke work index is a useful but invasively measured parameter that can be used to predict right heart failure following continuous-flow left ventricular assist device implantation. Right ventricular contraction pressure index is a novel parameter that was developed to measure right ventricular stroke work index with echocardiography. We aimed to investigate the clinical usefulness of right ventricular contraction pressure index to predict short-term mortality and right heart failure in patients who underwent continuous-flow left ventricular assist device implantation.
Methods:
A total of 49 patients who participated in institutional advanced heart failure registry and underwent continuous-flow left ventricular assist device implantation with a bridge-to-candidacy indication were analyzed retrospectively. Right ventricular contraction pressure index was calculated using offline measurements. Demographic, clinical and outcome data were obtained from the registry data. Patients were grouped according to right ventricular contraction pressure index quartiles.
Results:
Patients within the lowest right ventricular contraction pressure index quartile had a trend toward higher short-term mortality (46.2%, p = 0.056) and combined short-term mortality and definitive right heart failure (53.8%, p = 0.054) at 15th day postoperatively. Similarly, short-term survival or survival free of definite right heart failure were significantly lower in the lowest right ventricular contraction pressure index quartile (log-rank p = 0.045 and log-rank p = 0.03, respectively). In a proportional hazards model that included echocardiographic parameters, right ventricular contraction pressure index was an independent predictor for short-term mortality (odds ratio: 6.777, 95% confidence interval: 1.118–41.098, p = 0.037), but not for combined short-term mortality and definite right heart failure. No such associations were found for long-term mortality. Right ventricular contraction pressure index had a statistically significant correlation with invasively measured pulmonary capillary wedge pressure, pulmonary vascular resistance, mean pulmonary pressure, and right ventricular stroke work index.
Conclusion:
Right ventricular contraction pressure index was found as a useful parameter for determining short-term postoperative mortality in patients undergoing continuous-flow left ventricular assist device implantation.