Introduction
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.
Methods
(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.
Results
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)
Discussion
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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© 2021 Published by Elsevier Inc.
