Abstract 12924: The Role of Cardiac Magnetic Resonance Imaging Derived-Right Ventricular Ejection Fraction in Predicting the Risk of Right Heart Failure in Patients Who Underwent Left Ventricular Assist Device Implantation

Introduction:Despite the advancement in the left ventricular assist devices (LVADs), right heart failure (RHF) remains a challenging adverse event after LVAD implantation and is associated with increased morbidity and mortality. Cardiac magnetic resonance (CMR)-derived right ventricular ejection fraction (RVEF) is a promising surrogate of the right ventricular function and is an independent predictor of major cardiovascular events. In this study, we aim to assess the role of CMR-derived RVEF in predicting the risk of post-LVAD RHF.Methods:We retrospectively assessed adult patients (>18 years) who underwent CMR prior to LVAD implantation at our center from 2016 to 2021. Overall baseline characteristics and clinical outcomes were compared between the patients who developed post-LVAD RHF and those who did not.Results:A total of 42 patients were included in this study. Nine patients (21%) developed RHF; four had early post-implant RHF, and five had late RHF. The mean age was 47±14 years, and 76% were males. Most of the patients were on milrinone infusion at LVAD implantation (69%). The mean cardiac index (using the thermodilution method) was 1.5±0.8 ml/kg/m2, and CMR-derived LVEF was 17±7%. About half of the patients were on destination therapy, and half were on a bridge-to-transplant strategy. The mean CMR-derived RVEF was 25±13%, with no statistically significant difference between the two groups. The mean of the CMR-derived right ventricular volume index trend was higher in those with post-LVAD RHF but did not achieve statistical significance (76±28 ml/m2 vs. 65±25 ml/m2; p=0.31). Patients with post-LVAD RHF had lower mean arterial pressure (MAP) at the time of the right heart catheterization (77±10 vs. 85±12 mmHg; p0.039) and had more HF hospitalizations (2.7±2.2 vs. 0.7±1.5 hospitalizations; p=0.001).Conclusions:In patients who underwent CMR prior to LVAD implantation, CMR-derived RVEF was not an independent predictor of post-LVAD RHF. Larger multicenter studies are needed to confirm this finding.