PMID- 27469015 OWN - NLM STAT- MEDLINE DCOM- 20180301 LR - 20180614 IS - 1557-3117 (Electronic) IS - 1053-2498 (Linking) VI - 36 IP - 1 DP - 2017 Jan TI - Right ventricular response to pulsatile load is associated with early right heart failure and mortality after left ventricular assist device. PG - 97-105 LID - S1053-2498(16)30193-0 [pii] LID - 10.1016/j.healun.2016.06.015 [doi] AB - BACKGROUND: Right ventricular (RV) adaptation to afterload is crucial for patients undergoing continuous-flow left ventricular assist device (cf-LVAD) implantation. We hypothesized that stratifying patients by RV pulsatile load, using pulmonary arterial compliance (PAC), and RV response to load, using the ratio of central venous to pulmonary capillary wedge pressure (CVP:PCWP), would identify patients at high risk for early right heart failure (RHF) and 6-month mortality after cf-LVAD. METHODS: During the period from January 2008 to June 2014, we identified 151 patients at our center with complete hemodynamics prior to cf-LVAD. Pulsatile load was estimated using PAC indexed to body surface area (BSA), according to the formula: indexed PAC (PACi) = [SV / (PA(systolic) - PA(diastolic))] / BSA, where SV is stroke volume and PA is pulmonary artery. Patients were divided into 4 hemodynamic groups by PACi and CVP:PCWP. RHF was defined as the need for unplanned RVAD, inotropic support >/=14 days or death due to RHF within 14 days. Risk factors for RHF and 6-month mortality were examined using logistic regression and Cox proportional hazards modeling. RESULTS: Sixty-one patients (40.4%) developed RHF and 34 patients (22.5%) died within 6 months. Patients with RHF had lower PACi (0.92 vs 1.17 ml/mm Hg/m(2), p = 0.008) and higher CVP:PCWP (0.48 vs 0.37, p = 0.001). Higher PACi was associated with reduced risk of RHF (adjusted odds ratio [adj-OR] 0.61, 95% confidence interval [CI] 0.39 to 0.94, p = 0.025) and low PACi with increased risk of 6-month mortality (adjusted hazard ratio [adj-HR] 3.18, 95% CI 1.40 to 7.25, p = 0.006). Compared to patients with low load (high PACi) and adequate right heart response to load (low CVP:PCWP), patients with low PACi and high CVP:PCWP had an increased risk of RHF (OR 4.74, 95% CI 1.23 to 18.24, p = 0.02) and 6-month mortality (HR 8.68, 95% CI 2.79 to 26.99, p < 0.001). CONCLUSIONS: A hemodynamic profile combining RV pulsatile load and response to load identifies patients at high risk for RHF and 6-month mortality after cf-LVAD. CI - Copyright (c) 2016 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved. FAU - Grandin, E Wilson AU - Grandin EW AD - Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA. Electronic address: edward.grandin@uphs.upenn.edu. FAU - Zamani, Payman AU - Zamani P AD - Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA. FAU - Mazurek, Jeremy A AU - Mazurek JA AD - Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA. FAU - Troutman, Gregory S AU - Troutman GS AD - Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA. FAU - Birati, Edo Y AU - Birati EY AD - Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA. FAU - Vorovich, Esther AU - Vorovich E AD - Division of Cardiovascular Medicine, Northwestern University, Chicago, Illinois, USA. FAU - Chirinos, Julio A AU - Chirinos JA AD - Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA. FAU - Tedford, Ryan J AU - Tedford RJ AD - Division of Cardiovascular Medicine, Johns Hopkins University, Baltimore, Maryland, USA. FAU - Margulies, Kenneth B AU - Margulies KB AD - Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA. FAU - Atluri, Pavan AU - Atluri P AD - Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA. FAU - Rame, J Eduardo AU - Rame JE AD - Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20160624 PL - United States TA - J Heart Lung Transplant JT - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation JID - 9102703 SB - IM MH - Equipment Failure MH - Female MH - Follow-Up Studies MH - Heart Failure/complications/mortality/physiopathology/*therapy MH - Heart Ventricles/*physiopathology MH - Heart-Assist Devices/*adverse effects MH - Humans MH - Male MH - Middle Aged MH - Pulmonary Artery/*physiopathology MH - Pulmonary Wedge Pressure MH - Pulsatile Flow/*physiology MH - Retrospective Studies MH - Risk Factors MH - Stroke Volume MH - Survival Rate/trends MH - Time Factors MH - United States/epidemiology MH - Ventricular Dysfunction, Right/etiology/mortality/*therapy OTO - NOTNLM OT - LVAD OT - pulmonary arterial compliance OT - pulsatile load OT - right heart failure OT - survival EDAT- 2016/07/30 06:00 MHDA- 2018/03/02 06:00 CRDT- 2016/07/30 06:00 PHST- 2015/11/21 00:00 [received] PHST- 2016/05/19 00:00 [revised] PHST- 2016/06/22 00:00 [accepted] PHST- 2016/07/30 06:00 [pubmed] PHST- 2018/03/02 06:00 [medline] PHST- 2016/07/30 06:00 [entrez] AID - S1053-2498(16)30193-0 [pii] AID - 10.1016/j.healun.2016.06.015 [doi] PST - ppublish SO - J Heart Lung Transplant. 2017 Jan;36(1):97-105. doi: 10.1016/j.healun.2016.06.015. Epub 2016 Jun 24.