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Comparative Analysis of Established Risk Scores and Novel Hemodynamic Metrics in Predicting Right Ventricular Failure in Left Ventricular Assist Device Patients.
- Source :
-
Journal of cardiac failure [J Card Fail] 2019 Aug; Vol. 25 (8), pp. 620-628. Date of Electronic Publication: 2019 Feb 18. - Publication Year :
- 2019
-
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.<br />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).<br />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.<br /> (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Cohort Studies
Female
Heart Failure diagnosis
Heart Ventricles
Hospital Mortality trends
Humans
Male
Middle Aged
Predictive Value of Tests
Retrospective Studies
Risk Factors
Ventricular Dysfunction, Right diagnosis
Heart Failure mortality
Heart Failure physiopathology
Heart-Assist Devices trends
Hemodynamics physiology
Ventricular Dysfunction, Right mortality
Ventricular Dysfunction, Right physiopathology
Subjects
Details
- Language :
- English
- ISSN :
- 1532-8414
- Volume :
- 25
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Journal of cardiac failure
- Publication Type :
- Academic Journal
- Accession number :
- 30790625
- Full Text :
- https://doi.org/10.1016/j.cardfail.2019.02.011