A Novel Metrics to Predict Right Heart Failure after Left Ventricular Assist Device Implantation

Purpose Right Heart failure (RHF) is a severe complication after left ventricular assist device (LVAD) implantation, increasing early and late mortality. Although numerous RHF predictive models have been developed, there are few independent comparative analyses of these risk models.We aimed to compare the existent risk scores models and to identify the best predictors of severe RHF at our center. Methods Early severe RHF was defined as use of inotropes for ≥14 days, nitric oxide use for ≥48 hours or unplanned right-sided circulatory support. A logistic regression model was fitted right ventricular failure from individual variables selected by a likelihood ratio chi-square test or by fitting a univariate logistic regression model to obtain a likelihood ratio test. All variables with a p-value Results Among 92 LVAD patients retrospectively reviewed from 2011 to 2020, 24 (26%) developed early severe RHF.In the comparative analysis of the 3 predictive scores, the EUROMACS-RHF risk score performed the best in predicting RHF (C=0.82 - 95% CI: 0.68-0.90).Our new model was based on four variables, selected for the best reduced logistic model: the INTERMACS scale, the number of inotropes, ratio of right atrial/pulmonary capillary wedge pressure (RAP/PWCP) and ratio of right ventricle/left ventricle (RV/LV) diameters. This model demonstrated significant discrimination of RHF (C=0.91 - 95% CI: 0.76-0.96). Conclusion Amongst the available risk scores, the EUROMACS performs best to predict the occurrence of RHF after LVAD implantation. Based on 4 simple metrics, our model's performance compares well to the EUROMACS score.