Right heart reserve function assessed with fluid loading predicts late right heart failure after left ventricular assist device implantation

Masaki Tsuji; Takahiro Kurihara; Yoshitaka Isotani; Chie Bujo; Junichi Ishida; Eisuke Amiya; Masaru Hatano; Asako Shimada; Hiroko Imai; Mitsutoshi Kimura; Shogo Shimada; Masahiko Ando; Minoru Ono; Issei Komuro

doi:10.1016/j.cjca.2024.02.012

Right heart reserve function assessed with fluid loading predicts late right heart failure after left ventricular assist device implantation

Can J Cardiol. 2024 Feb 23:S0828-282X(24)00176-4. doi: 10.1016/j.cjca.2024.02.012. Online ahead of print.

Authors

Affiliations

¹ Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. Electronic address: mtsuji-cib@umin.ac.jp.
² Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
³ Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Tokyo, Japan.
⁴ Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Advanced Medical Center for Heart Failure, Graduate School of Medicine, The University of Tokyo, Japan.
⁵ Department of Organ Transplantation, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁶ Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁷ Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Frontier Cardiovascular Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; International University of Health and Welfare, Tokyo, Japan.

PMID: 38402951
DOI: 10.1016/j.cjca.2024.02.012

Abstract

Background: A left ventricular assist device (LVAD) is an effective therapeutic option for advanced heart failure. Late right heart failure (LRHF) is a complication after LVAD implantation associated with increasing morbidity and mortality; however, the assessment of right heart function, including right heart reserve function after LVAD implantation, has not been established. We focused on a fluid loading test with right heart catheterization (RHC) to evaluate right heart pre-load reserve function and investigate its impact on LRHF.

Methods: Patients aged > 18 who received continuous-flow LVAD between November 2007 and December 2022 at our institution and underwent RHC with saline loading (10ml/kg for 15 min) 1 month after LVAD implantation were included.

Results: Overall, 31 LRHF or deaths (RHF group) have occurred in 149 patients. Comparing the RHF and non-RHF groups, pulmonary artery pulsatility index (PAPi) at rest (1.8±0.89 vs. 2.5±1.4, p=0.02) and right ventricular stroke work index (RVSWi) change ratio with saline loading (0.96±0.32 vs. 1.1±0.20, p=0.03) was significantly different. The PAPi at rest and RVSWi change ratio with saline loading were identified as the postoperative risks for LRHF or death. The cohort was divided into three groups based on whether the PAPi at rest and RVSWi change ratio were low. The event-free curve significantly differed between the three groups (p<0.001).

Conclusions: Hemodynamic assessment with saline loading can evaluate the right ventricular pre-load reserve function of patients with LVAD. The low RVSWi change with saline loading was a risk factor for LRHF following LVAD implantation.

Keywords: Late right heart failure; fluid loading test; left ventricular assist device; right heart reserve function.