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The Combination of Tricuspid Annular Plane Systolic Excursion and HeartMate Risk Score Predicts Right Ventricular Failure After Left Ventricular Assist Device Implantation

Raymer, David S.; Moreno, Jonathan D.; Sintek, Marc A.; Nassif, Michael E.; Sparrow, Christopher T.; Adamo, Luigi; Novak, Eric L.; LaRue, Shane J.; Vader, Justin M.

doi: 10.1097/MAT.0000000000000808
Adult Circulatory Support

Right ventricular (RV) failure is difficult to predict and is a major determinant of poor outcomes after left ventricular assist device (LVAD) implantation. We evaluated the associations of the following variables with severe RV failure in LVAD patients: tricuspid annular plane systolic excursion (TAPSE), pulmonary artery pulsatility index (PAPi), simplified RV contraction pressure index (sRVCPI), and HeartMate Risk Score (HMRS). We performed a retrospective case-control study on 216 patients who underwent continuous-flow LVAD implantation between 2008 and 2014. The primary analysis assessed the ability of HMRS, PAPi, sRVCPI, and TAPSE to predict severe RV failure. A secondary analysis evaluated the incremental benefit of combining predictive variables. Seventy-four patients developed severe RV failure (24%). Compared with the control group, the severe RV failure group had lower TAPSE (1.30 vs. 1.55; p < 0.001), lower PAPi (1.77 vs. 2.47; p = 0.001), lower sRVCPI (42.71 vs. 57.82; p < 0.001), and higher HMRS (2.12 vs. 1.65; p < 0.001). All four variables had similar receiver operating characteristic curves with modest area under the receiver operating characteristic curve (0.63–0.67, all p values < 0.001). In the evaluation of combined predictive variables, the combination of TAPSE with HMRS was found to be best for predicting severe RV failure. In summary, patients at risk for severe RV failure after LVAD implantation were successfully identified using TAPSE, PAPi, sRCPI, and HMRS. The combination of TAPSE and HMRS—incidentally, the least invasive and most readily available variables—proved to be superior to RV-centric metrics for predicting severe RV failure. The predictive and clinical use of these two variables should be tested prospectively.

From the Barnes-Jewish Hospital, Cardiovascular Division, Washington University, St. Louis., Missouri.

Submitted for consideration November 2017; accepted for publication in revised form March 2018.

Disclosure: All authors declare no conflicts of interest related to this study.

Supported, in part, by research funds from the National Institutes of Health (Grant No. U10 HL110309, Heart Failure Network), Clinical and Translational Science Award (Grant No. UL1 TR000448), and the Barnes Jewish Hospital Foundation.

David S. Raymer and Jonathan D. Moreno contributed equally to this work.

Correspondence: David Raymer, Barnes-Jewish Hospital, Washington University, 660 South Euclid Ave., Campus Box 8086, St. Louis, MO 63110. Email:

Copyright © 2019 by the American Society for Artificial Internal Organs