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• W2743004623 abstract "Right ventricular failure (RVF) after implantation of a left ventricular assist device (LVAD) is associated with increased morbidity and mortality. Accurately predicting RVF in this setting can influence surgical decision-making. One of the mechanisms responsible for early RVF after LVAD placement is the increase in preload to the right ventricle (RV). This is similar to the increase in preload that occurs during exercise. We hypothesize that exercise parameters obtained from Cardiopulmonary Exercise Testing (CPET) may be able to predict RVF post LVAD implantation. It has been shown previously, that the VE/VCO2 slope at anaerobic threshold (AT) increases proportionately with mean pulmonary pressures and is inversely related with RV function. We used the following formula to calculate the Right Ventricle Stress Score (RVSS): RVSS = VE/VCO2 (at AT)/Heart Rate (at peak exercise). We conducted a retrospective analysis of 24 patients who had CPETs performed before LVAD placement. RVF was defined as the need for inotropes (milrinone or dobutamine) for more than 14 days or need for mechanical RV support. Patients with pulmonary capillary wedge pressure over 30 mmHg were excluded. Out of 24 patients, 8 developed RVF. Of these, 6 patients required inotrope therapy for a mean duration of 23.83 ± 7.12 days, while 2 patients required mechanical RV support. The remaining 16 patients did not develop RVF according to the specified definition. Post-operative inotropes were used in 15 of these patients for a mean duration of 7.27 ± 2.60 days and 1 patient did not require any post-operative RV support. The average time between the CPET and LVAD placement was 139.6 ± 107.2 days. The ROC curve for RVSS (see figure) showed an AUC of 0.781 (CI 0.592–0.970, P value .027). In the same patient cohort, the average duration between a right heart catheterization (RHC) and LVAD placement was 109.4 ± 98.45 days. The mean pulmonary capillary wedge pressure was 16.5 ± 6.2 mmHg. We also calculated the AUC for Right Ventricular Stroke Work Index, which was 0.539 (CI 0.289–0.789, P value .759) and Pulmonary Artery Pulsatility Index, which was 0.496 (CI 0.219–0.773, P value .976). Using a cut-off of 0.33 for RVSS, the sensitivity of the test was 87.5% and specificity was 62.5% for RVF. The negative predictive value was 91%. The RVSS may be a useful index in predicting RVF after LVAD implantation." @default.
• W2743004623 created "2017-08-17" @default.
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• W2743004623 date "2017-08-01" @default.
• W2743004623 modified "2023-09-26" @default.
• W2743004623 title "Cardiopulmonary Exercise Test Derived Score to Predict Right Ventricular Failure after Left Ventricular Assist Device Placement" @default.
• W2743004623 doi "https://doi.org/10.1016/j.cardfail.2017.07.364" @default.
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