3D echocardiography derived right ventricular function is associated with right ventricular failure and mid-term survival after left ventricular assist device implantation

Abstract

Background: Right heart failure remains a major cause of morbidity and mortality after left ventricular assist device (LVAD) implantation. Multiple 2D echocardiography derived parameters are associated with right ventricular failure (RV failure), but none of them has been proven to be a reliable predictor to date. We hypothesized that novel 3D-echocardiography (3DE) based parameters are associated with RV failure and predict long term outcome in patients undergoing LVAD implantation.

Methods: This single-center study retrospectively enrolled 26 patients undergoing continuous-flow LVAD implantation. RV failure was defined as prolonged inotropic support for >14 days after LVAD implantation or consecutive implantation of a right ventricular assist device. Based on transesophageal 3DE datasets acquired prior to surgery right ventricular size, ejection fraction and longitudinal strains were calculated.

Results: The overall RV failure rate was 19.2%. Patients suffering from RV failure had a significantly impaired 3D-right ventricular ejection fraction (3D-RVEF; 28 ± 2% vs. 19 ± 3%, p = 0.0145) and 3D derived RV free wall longitudinal strain (3D-RV-fws; -13.2 ± 0.97% vs. -6.4 ± 1.98%; p = 0.0056) when compared to patients without RV failure. ROC analysis for 3D-RV-fws (AUC 0.914) and 3D-RVEF (AUC 0.876) showed high discriminative capabilities in regard to detection of RV failure. Kaplan-Meier analysis showed an improved long-term survival of patients with a 3D-RV-fws <-11.9%.

Conclusions: 3D-echocardiography derived RV ejection fraction and RV free wall strain are associated with right ventricular failure and long term outcome in patients undergoing LVAD implantation. These parameters have the potential to be future predictors for right heart failure in LVAD surgery.

Keywords: 3D echocardiography; Left ventricular assist device; Outcome; Right ventricular failure; Right ventricular strain.