Background: Although right ventricular failure (RVF) is a common complication after left ventricular assist device (LVAD) implantation, its occurrence cannot be reliably predicted by an individual echocardiographic parameter or a simple combination of measurements. (1, 2) We aimed to identify easily obtainable measurements that may successfully predict RVF, combining markers of right atrial (RA) and right ventricular (RV) geometry with hemodynamic measurements.

Patients and Methods: Preoperative echo examinations and right heart catheterization (RHC) data were studied for 48 consecutive patients (pts) (42 male, mean age 59.1±8.7 years), who underwent continuous flow LVAD implantation (80% HeartMate II/III, 20% HeartWare). A standard preoperative echo examination was performed, assessing RV and RA geometry and function (TAPSE (tricuspid annular plane systolic excursion), FAC (fractional area change)), while haemodynamic parameters were measured by RHC (Table 1). The Index of RV asymmetry (RVAi) was used as a novel marker of RV geometry, quantified as a ratio of the difference of the medial and lateral portion of RV area in relation to the total RV area at enddiastole (Figure 1).

Results: 19% of pts presented with acute or chronic RVF following LVAD implantation. The RVAi was significantly higher (a more assymetric RV) in nonRVF patients: 0.40±0.13 vs 0.25±0.1, p<0.005. The combination of RAvol/BSA (right atrial volume indexed to BSA) and RVAi was confirmed as a superior predictor of RVF, while the addition of PVR maximized the specificity, yet impaired the sensitivity of the testing. The traditional markers of RV function, FAC and TAPSE, failed to successfully distinguish patients that would develop RVF (Table 1).

Conclusion: Our study demonstrates that echocardiographic parameters of RV and RA geometry combined with RHC parameters of RV afterload may be simple yet reliable predictors of post LVAD RVF; however, limited patient numbers suggest further testing of this finding.