Right heart failure before LVAD implantation predicts right heart failure after LVAD implantation - is it that easy?
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Right heart failure before LVAD implantation predicts right heart failure after LVAD implantation - is it that easy? / Wagner, Tobias; Bernhardt, Alexander M; Magnussen, Christina; Reichenspurner, Hermann; Blankenberg, Stefan; Grahn, Hanno.
in: J CARDIOTHORAC SURG, Jahrgang 15, Nr. 1, 113, 25.05.2020.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Right heart failure before LVAD implantation predicts right heart failure after LVAD implantation - is it that easy?
AU - Wagner, Tobias
AU - Bernhardt, Alexander M
AU - Magnussen, Christina
AU - Reichenspurner, Hermann
AU - Blankenberg, Stefan
AU - Grahn, Hanno
PY - 2020/5/25
Y1 - 2020/5/25
N2 - BACKGROUND: Right heart failure (RHF) after left ventricular assist device (LVAD) implantation is common and associated with worse outcome. Prediction of RHF remains challenging. Our study aims to assess predictors of RHF focusing on clinical manifestations.METHODS: We retrospectively analyzed clinical, echocardiographic and hemodynamic parameters of 112 patients undergoing LVAD implantation. Pre-operative, early (ERHF, day 7 and 14) and late postoperative RHF (LRHF, after 1, 3, 6 and 12 months) were assessed.RESULTS: In the total study population (87.5% men, mean age 55 years), early RHF was frequent (47% on day 7 and 30% on day 14). Prevalence of late RHF and death from RHF was high after 3, 6 and 12 months (23, 24 and 17%). Pre-existing RHF was only associated with early RHF and persistent, but not for new onset late RHF. Early RHF was associated with lower INTERMACS level (p < 0.001), higher pulmonary vascular resistance (p = 0.046) and CVP/PAWP quotient (p = 0.011), higher bilirubin (p = 0.038) and creatinine (p = 0.013). LRHF was associated with creatinine (p = 0.006), urea (p = 0.012) and load adaption index (p = 0.007). Binary logistic regression models identified no single risk factors. Comparing the predictive value of regression models with a model of three clinical findings (INTERMACS level, age and pre-operative RHF) did not reveal differences in RHF.CONCLUSIONS: RHF before LVAD implantation enhances the risk of early RHF and persistent late RHF, but not for new onset late RHF, supporting the hypothesis of differences in the etiology. Echocardiographic or hemodynamic parameters did not show a predictive value for new onset late RHF. Similar predictive value of clinical findings and statistic models of risk factors suggest that a clinical evaluation is equally matched to predict RHF.
AB - BACKGROUND: Right heart failure (RHF) after left ventricular assist device (LVAD) implantation is common and associated with worse outcome. Prediction of RHF remains challenging. Our study aims to assess predictors of RHF focusing on clinical manifestations.METHODS: We retrospectively analyzed clinical, echocardiographic and hemodynamic parameters of 112 patients undergoing LVAD implantation. Pre-operative, early (ERHF, day 7 and 14) and late postoperative RHF (LRHF, after 1, 3, 6 and 12 months) were assessed.RESULTS: In the total study population (87.5% men, mean age 55 years), early RHF was frequent (47% on day 7 and 30% on day 14). Prevalence of late RHF and death from RHF was high after 3, 6 and 12 months (23, 24 and 17%). Pre-existing RHF was only associated with early RHF and persistent, but not for new onset late RHF. Early RHF was associated with lower INTERMACS level (p < 0.001), higher pulmonary vascular resistance (p = 0.046) and CVP/PAWP quotient (p = 0.011), higher bilirubin (p = 0.038) and creatinine (p = 0.013). LRHF was associated with creatinine (p = 0.006), urea (p = 0.012) and load adaption index (p = 0.007). Binary logistic regression models identified no single risk factors. Comparing the predictive value of regression models with a model of three clinical findings (INTERMACS level, age and pre-operative RHF) did not reveal differences in RHF.CONCLUSIONS: RHF before LVAD implantation enhances the risk of early RHF and persistent late RHF, but not for new onset late RHF, supporting the hypothesis of differences in the etiology. Echocardiographic or hemodynamic parameters did not show a predictive value for new onset late RHF. Similar predictive value of clinical findings and statistic models of risk factors suggest that a clinical evaluation is equally matched to predict RHF.
KW - Cardiac Surgical Procedures/adverse effects
KW - Echocardiography
KW - Female
KW - Heart Failure/diagnostic imaging
KW - Heart-Assist Devices/adverse effects
KW - Humans
KW - Male
KW - Middle Aged
KW - Postoperative Complications
KW - Retrospective Studies
KW - Risk Factors
KW - Vascular Resistance
U2 - 10.1186/s13019-020-01150-x
DO - 10.1186/s13019-020-01150-x
M3 - SCORING: Journal article
C2 - 32450890
VL - 15
JO - J CARDIOTHORAC SURG
JF - J CARDIOTHORAC SURG
SN - 1749-8090
IS - 1
M1 - 113
ER -