Right ventricular-pulmonary arterial coupling in patients with implanted left ventricular assist devices

Maciej Stąpór; Dorota Sobczyk; Grzegorz Wasilewski; Karol Wierzbicki; Andrzej Gackowski; Paweł Kleczyński; Krzysztof Żmudka; Bogusław Kapelak; Jacek Legutko

doi:10.1016/j.hjc.2023.06.002

Right ventricular-pulmonary arterial coupling in patients with implanted left ventricular assist devices

Hellenic J Cardiol. 2023 Jun 7:S1109-9666(23)00107-0. doi: 10.1016/j.hjc.2023.06.002. Online ahead of print.

Authors

Maciej Stąpór¹, Dorota Sobczyk², Grzegorz Wasilewski², Karol Wierzbicki², Andrzej Gackowski³, Paweł Kleczyński⁴, Krzysztof Żmudka⁴, Bogusław Kapelak², Jacek Legutko⁵

Affiliations

¹ Clinical Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland; Noninvasive Cardiovascular Laboratory, John Paul II Hospital, Kraków, Poland.
² Jagiellonian University Medical College, Institute of Cardiology, Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Kraków, Poland.
³ Jagiellonian University Medical College, Institute of Cardiology, Department of Coronary Disease and Heart Failure, John Paul II Hospital, Kraków, Poland; Noninvasive Cardiovascular Laboratory, John Paul II Hospital, Kraków, Poland.
⁴ Clinical Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland; Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland.
⁵ Clinical Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland; Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland. Electronic address: jacek.legutko@uj.edu.pl.

PMID: 37295669
DOI: 10.1016/j.hjc.2023.06.002

Abstract

Objective: Both the right ventricular (RV) contractile function and pulmonary arterial (PA) pressure influence clinical outcomes in patients supported with left ventricular assist devices (LVADs), but the impact of RV-PA coupling is unknown. This study aimed to determine the prognostic impact of RV-PA coupling in patients with implanted LVADs.

Methods: Patients with implanted third-generation LVADs were retrospectively enrolled. The RV-PA coupling was assessed preoperatively by the ratio of RV free wall strain (RVFWS) derived from speckle-tracking echocardiography and noninvasively measured peak RV systolic pressure (RVSP). The primary end point was a composite of all-cause mortality or right heart failure (RHF) hospitalization. Secondary end points consisted of all-cause mortality at a 12-month follow-up and RHF hospitalization.

Results: A total of 103 patients were screened, and 72 with good RV myocardial imaging were included. The median age was 57 years; 67 patients (93.1%) were men, and 41 (56,9%) had dilated cardiomyopathy. A receiver-operating characteristic analysis (AUC 0.703, 51.5% sensitivity, 94.9% specificity) was used to identify the optimal cutoff point (0.28%/mmHg) for the RVFWS/TAPSE threshold. Nineteen subjects (26.4%) had advanced RV-PA uncoupling. Event rates were estimated using the Kaplan-Meier method showing a strong association with an increased risk for the primary end point of death or RHF hospitalization (89.47% vs. 30.19%, p < 0.001). A similar observation applied to all-cause mortality (47.37% vs. 13.21%, p = 0.003) and RHF hospitalization (80.43% vs. 20%, p < 0.001).

Conclusions: An advanced RV dysfunction assessed by RV-PA coupling may serve as a predictor of adverse outcomes in patients with implanted LVADs.

Keywords: Chronic heart failure; Left ventricular assist device; Mechanical circulatory support; Speckle-tracking echocardiography; Strain imaging.