006 THE VALUE OF TAPSE IN THE ASSESSMENT OF RIGHT VENTRICULAR FAILURE COMPLICATING LVAD THERAPY

Introduction Right ventricular (RV) failure in left ventricular assist device (LVAD) recipients, is associated with unfavourable outcomes. Right heart haemodynamic parameters, including RV stroke work index (RVSWI), remain the gold standard in the RV function assessment. Tricuspid annular plane systolic excursion (TAPSE) is an echocardiographic parameter, which is commonly used in the follow-up of these patients. The aim of this study is to investigate the utility of TAPSE in the prediction of RV failure (RVF) in patients undergoing LVAD implantation. Methods Retrospective study of 68 patients with left heart failure (48±11 years, 58 males, ejection fraction: 22.1±1.2, ischaemic aetiology: 32%), who underwent LVAD implantation at Harefield Hospital (January 2010 and September 2012). Patients who initially required biventricular mechanical support were not included in the study. TAPSE measurements were obtained preoperatively, in the immediate postoperative period ( Results Eighteen LVAD-recipients (26.4%) developed RVF postoperatively and presented significantly lower survival rates (p 0.2). The correlation between pre-operative TAPSE and RVSWI was weak (r=0.31). RVSWI at 12 months presented improvement compared to baseline measurements (6.89±3.5 vs 6.25±3.6), despite the slight deterioration noted at 6 months (5.16±2.97). However, these postoperative RVSWI changes were not statistically significant (p>0.15). TAPSE was significantly higher pre-LVAD implantation (13.1±4.1) compared to the immediate postoperative values (8.8±2.8, p 0.27) between the pre- and post-operative LVEF (Simpson9s biplane) and cardiac index (thermodilution). Although at the 3-, 6- and 12-month follow-ups, TAPSE was significantly higher to the immediate postoperatively values (p Conclusions TAPSE presents significant decrease in the immediate post-LVAD implantation period. Despite a gradual improvement within a year and the parallel RVSWI recovery, it remains significantly lower than its baseline values in all LVAD recipients, even in those without clinical RVF. The degree of postoperative TAPSE decline did not appear to correlate with RVF risk, RV recovery or survival rate.