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. 2008 Jun 3;51(22):2163-72.
doi: 10.1016/j.jacc.2008.03.009.

The right ventricular failure risk score a pre-operative tool for assessing the risk of right ventricular failure in left ventricular assist device candidates

Jennifer Cowger Matthews  1 , Todd M Koelling, Francis D Pagani, Keith D Aaronson
Affiliations

The right ventricular failure risk score a pre-operative tool for assessing the risk of right ventricular failure in left ventricular assist device candidates

Jennifer Cowger Matthews et al. J Am Coll Cardiol. .

Abstract

Objectives: This study sought to develop a model that estimates the post-operative risk of right ventricular (RV) failure in left ventricular assist device (LVAD) candidates.

Background: Right ventricular failure after LVAD surgery is associated with increased morbidity and mortality, but identifying LVAD candidates at risk for RV failure remains difficult.

Methods: A prospectively collected LVAD database was evaluated for pre-operative clinical, laboratory, echocardiographic, and hemodynamic predictors of RV failure. Right ventricular failure was defined as the need for post-operative intravenous inotrope support for >14 days, inhaled nitric oxide for > or =48 h, right-sided circulatory support, or hospital discharge on an inotrope. An RV failure risk score (RVFRS) was created from multivariable logistic regression model coefficients, and a receiver-operating characteristic curve of the score was generated.

Results: Of 197 LVADs implanted, 68 (35%) were complicated by post-operative RV failure. A vasopressor requirement (4 points), aspartate aminotransferase > or =80 IU/l (2 points), bilirubin > or =2.0 mg/dl (2.5 points), and creatinine > or =2.3 mg/dl (3 points) were independent predictors of RV failure. The odds ratio for RV failure for patients with an RVFRS < or =3.0, 4.0 to 5.0, and > or =5.5 were 0.49 (95% confidence interval [CI] 0.37 to 0.64), 2.8 (95% CI 1.4 to 5.9), and 7.6 (95% CI 3.4 to 17.1), respectively, and 180-day survivals were 90 +/- 3%, 80 +/- 8%, and 66 +/- 9%, respectively (log rank for linear trend p = 0.0045). The area under the receiver-operating characteristic curve for the RVFRS (0.73 +/- 0.04) was superior to that of other commonly used predictors of RV failure (all p < 0.05).

Conclusions: The RVFRS, composed of routinely collected, noninvasive pre-operative clinical data, effectively stratifies the risk of RV failure and death after LVAD implantation.

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Figures

Figure 1
Figure 1. ROC Curve of the RVFRS and Other Univariable Predictors of RV Failure
Table 7 shows the areas under the receiver-operating characteristic (ROC) curve for the predictors. PAS = pulmonary artery systolic; PVR = pulmonary vascular resistance; RA = right atrial; RV = right ventricular; RVFRS = right ventricular failure risk score; RVSWI = right ventricular stroke work index; TPG = transpulmonary gradient.
Figure 2
Figure 2. Kaplan-Meier Survival Curve for Each RV Failure Risk Score Strata
The 180-day post-left ventricular assist device survival curves for each score strata are displayed. RV = right ventricular.
See this image and copyright information in PMC

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