Right ventricular failure (RVF) remains as critical complications in durable LVAD patients. Avoiding severe RVF is essential especially in increasing destination LVAD patients because they have no exit strategies. An enlarged pulmonary artery (PA) and an increased pulmonary artery/aorta (PA/Ao) diameter ratio are associated with increased pulmonary artery pressure (PAP).(1) Previous studies have indicated that PA/Ao ratio, as assessed on computed tomography (CT), may be a useful diagnostic tool for pulmonary hypertension severity, in patients with COPD, and group 1 pulmonary hypertension.(2-3) However, the clinical significance of preoperative PA/Ao in right ventricular failure (RVF) after durable left ventricular assist device (LVAD) implantation has not been examined. We sought to investigate the prognostic impact of preoperative PA/Ao diameter ratio in durable LVAD patients with severe postoperative RVF.
(Following IRB approval,) we performed a single center retrospective study of patients receiving a durable LVAD between March 2013 and July 2019. RVF was categorized by non-severe and severe based on the INTERMACS criteria. The cohort were divided into severe RVF vs non-severe RVF. The aim of the study was to analyze the effect of preoperative PA/Ao diameter ratio to postoperative RVF. Also, receiver operating characteristics curve (ROC) and logistic regression model were utilized to sub-analyze the prediction quality and cut-off value of PA/Ao to severe RVF.
Among total of 219 cohort, 43 were excluded for unavailable hemodynamic data or CT scan, the remaining 176 were included and analyzed. Among 176 cohort, 44 (25.0%) developed severe RVF. Preoperative patient demographics, hemodynamics and CT findings are shown in Table 1. Severe RVF group had statistically larger preoperative PA diameter (P=0.05), smaller Ao diameter (P=0.02), and larger PA/Ao (P<0.01) compared to non-severe RVF group. Preoperative PVR, TPG, DPG were similar between 2 groups. ROC curve testing PA/Ao ratio's diagnostic ability to predict severe RVF, with an area under the curve result of 0.787. (Figure 1), Logistic regression curve predicted probability gives a cutoff point of 1.09. (Figure 2)
Our study showed PA/Ao diameter ratio is an easy noninvasive indicator with satisfactory diagnostic ability to predict postoperative severe RVF with cutoff value of 1.09. This non-invasive assessment could be more utilized in clinical decision making such as patient selection, preoperative optimization and timing of surgery to avoid postoperative severe RVF. A larger data set should focus on mortality effect and examine in more depth the relationship between PA/Ao ratio and PVR.
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