Comparative Analysis of Established Risk Scores and Novel Hemodynamic Metrics in Predicting Right Ventricular Failure in Left Ventricular Assist Device Patients

Anthony E. Peters, La Vone A. Smith, Priscilla Ababio, Khadijah Breathett, Timothy L. McMurry, Jamie L.W. Kennedy, Mohammad Abuannadi, J. Bergin, Sula Mazimba

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Background: Right ventricular failure (RVF) portends poor outcomes after left ventricular assist device (LVAD) implantation. Although numerous RVF predictive models have been developed, there are few independent comparative analyses of these risk models. Methods and Results: RVF was defined as use of inotropes for >14 days, inhaled pulmonary vasodilators for >48 hours or unplanned right ventricular mechanical support postoperatively during the index hospitalization. Risk models were evaluated for the primary outcome of RVF by means of logistic regression and receiver operating characteristic curves. Among 93 LVAD patients with complete data from 2011 to 2016, the Michigan RVF score (C = 0.74 [95% CI 0.61–0.87]; P = .0004) was the only risk model to demonstrate significant discrimination for RVF, compared with newer risk scores (Utah, Pitt, EuroMACS). Among individual hemodynamic/echocardiographic metrics, preoperative right ventricular dysfunction (C = 0.72 [95% CI 0.58–0.85]; P = .0022) also demonstrated significant discrimination of RVF. The Michigan RVF score was also the best predictor of in-hospital mortality (C = 0.67 [95% CI 0.52–0.83]; P = .0319) and 3-year survival (Kaplan-Meier log-rank 0.0135). Conclusions: In external validation analysis, the more established Michigan RVF score—which emphasizes preoperative hemodynamic instability and target end-organ dysfunction—performed best, albeit modestly, in predicting RVF and demonstrated association with in-hospital and long-term mortality.

Original languageEnglish (US)
Pages (from-to)620-628
Number of pages9
JournalJournal of cardiac failure
Volume25
Issue number8
DOIs
StatePublished - Aug 2019
Externally publishedYes

Keywords

  • Right heart failure
  • mechanical circulatory support
  • prediction models
  • preoperative end-organ dysfunction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint

Dive into the research topics of 'Comparative Analysis of Established Risk Scores and Novel Hemodynamic Metrics in Predicting Right Ventricular Failure in Left Ventricular Assist Device Patients'. Together they form a unique fingerprint.

Cite this