TY - JOUR
T1 - Assessment of right ventricular dysfunction predictors before the implantation of a left ventricular assist device in end-stage heart failure patients using echocardiographic measures (ARVADE)
T2 - Combination of left and right ventricular echocardiographic variables
AU - Aissaoui, Nadia
AU - Salem, Joe Elie
AU - Paluszkiewicz, Lech
AU - Morshuis, Michiel
AU - Guerot, Emmanuel
AU - Gorria, Gonzalo Martin
AU - Fagon, Jean Yves
AU - Gummert, Jan
AU - Diebold, Benoit
N1 - Publisher Copyright:
© 2015 Elsevier Masson SAS.
PY - 2015/5/1
Y1 - 2015/5/1
N2 - SummaryBackground Right ventricular failure (RVF) is a major cause of morbidity and mortality in left ventricular assist device (LVAD) recipients. Objectives To identify preoperative echocardiographic predictors of post-LVAD RVF. Methods Data were collected for 42 patients undergoing LVAD implantation in Germany. RVF was defined as the need for placement of a temporary right ventricular assist device or the use of inotropic agents for 14 days. Data for RVF patients were compared with those for patients without RVF. A score (ARVADE) 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 LVAD patients. Univariate analysis identified the following measurements as RVF risk factors: basal right ventricular end-diastolic diameter (RVEDD), minimal inferior vena cava diameter, pulsed Doppler transmitral E wave (Em), Em/tissue Doppler lateral systolic velocity (SLAT) ratio and Em/tissue Doppler septal systolic velocity (SSEPT) ratio. Em/SLAT ≥ 18.5 (relative risk [RR] 2.78, 95% confidence interval [CI] 1.38-5.60; P = 0.001), RVEDD ≥ 50 mm (RR 1.97, 95% CI 1.21-3.20; P = 0.008) and INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) level 1 (RR 1.74, 95% CI 1.04-2.91; P = 0.04) were independent predictors of RVF. An ARVADE score > 3 predicted the occurrence of post-implantation RVF with a sensitivity of 89% and a specificity of 74%. Conclusion The ARVADE score, combining one clinical variable and three echocardiographic measurements, is potentially useful for selecting patients for the implantation of an assist device.
AB - SummaryBackground Right ventricular failure (RVF) is a major cause of morbidity and mortality in left ventricular assist device (LVAD) recipients. Objectives To identify preoperative echocardiographic predictors of post-LVAD RVF. Methods Data were collected for 42 patients undergoing LVAD implantation in Germany. RVF was defined as the need for placement of a temporary right ventricular assist device or the use of inotropic agents for 14 days. Data for RVF patients were compared with those for patients without RVF. A score (ARVADE) 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 LVAD patients. Univariate analysis identified the following measurements as RVF risk factors: basal right ventricular end-diastolic diameter (RVEDD), minimal inferior vena cava diameter, pulsed Doppler transmitral E wave (Em), Em/tissue Doppler lateral systolic velocity (SLAT) ratio and Em/tissue Doppler septal systolic velocity (SSEPT) ratio. Em/SLAT ≥ 18.5 (relative risk [RR] 2.78, 95% confidence interval [CI] 1.38-5.60; P = 0.001), RVEDD ≥ 50 mm (RR 1.97, 95% CI 1.21-3.20; P = 0.008) and INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) level 1 (RR 1.74, 95% CI 1.04-2.91; P = 0.04) were independent predictors of RVF. An ARVADE score > 3 predicted the occurrence of post-implantation RVF with a sensitivity of 89% and a specificity of 74%. Conclusion The ARVADE score, combining one clinical variable and three echocardiographic measurements, is potentially useful for selecting patients for the implantation of an assist device.
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U2 - 10.1016/j.acvd.2015.01.011
DO - 10.1016/j.acvd.2015.01.011
M3 - Article
C2 - 25863429
AN - SCOPUS:84929839847
SN - 1875-2136
VL - 108
SP - 300
EP - 309
JO - Archives of Cardiovascular Diseases
JF - Archives of Cardiovascular Diseases
IS - 5
ER -