Assessment of Right Ventricle before the Implantation of Left Ventricular Assist Device by Echocardiographic Parameters (ARVADE)

Purpose The aim of the study is to identify preoperative echocardiographic predictors of post-LVAD Right ventricular failure (RVF). Methods and Materials Data were collected on 42 patients undergoing LVAD implantation in the heart and diabetes center in Germany. Echocardiographic measurements were supplemented by strain of RV. Data were compared between patients with and without RVF. A score was established with independent predictors of RVF by rounding the exponentiated regression model coefficients to the nearest 0.5. Results RVF occurred in 24 of 42 patients. The INTERMACS levels were lower in RVF patients. Basal end-diastolic RV diameter, right-to-left ventricular end-diastolic diameters and mitral E wave were higher in RVF patients whereas RVSWI was decreased.Em > 105 cm/s (RR 2.48, IC [1.40-4.38], p = 0.003), basal RVEDD (RR 1.74, IC [1.04-2.91], p = 0.037) and INTERMACS 1 level (RR1.70, IC [1.00 – 2.90], p = 0.049) were independent predictor of RVF. An ARVADE score > 2 can predict the occurrence of RVF with sensibility 92% and specificity 67%. Conclusions The ARVADE score can help to device selection. RVF patients n = 24 No RVF patients n = 18 P value FAC, % 12.5 [9.0-18.8] 13.8 [6.8-22.8] 0.30 Basal RVEDD, mm 50 [43-56] 42 [37-48] 0.016 Svd, cm/s 10.1 [7.8-12.5] 11.5 [9.6-13.5] 0.059 TAPSE, mm 15 [12-19] 17 [15-20] 0.16 Strain, % 8.9 [6.9-10. 3] 9.4 [8.6-11.5] 0.70 sPAP, mmHg 32 [24-43] 35 [32-43] 0.40 RVSWI, mmHg/m2/L 7.8 [5.3-12.5] 11.6 [6.1-18.7] 0.04 RVEDD-to-LVEDD ratio 0.65 [0.60-0.72] 0.58 [0.45-0.66] 0.02 LVEDD, mm 77 [67-84] 72 [70-76] 0.76 LVEF, % 18.4 [10.6-25.1] 17.2 [12.3-23.8] 0.56 Em, cm/s 106 [86-134] 85 [65-91] 0.008 Values are median (interquartile range) or n/N (%). FAC right ventricular fractional area change; Basal RVEDD basal RV end-diastolic diameter; TAPSE maximal systolic excursion of the tricuspid annulus, SRV RV tissue doppler systolic velocities; SPAP systolic pulmonary arterial pressure; RVSWI RV stroke work index; LVEDD LV end-diastolic diameter, LVEF LV ejection fraction; Em mitral E wave.