Predictive capabilities of the European registry for patients with mechanical circulatory support right-sided heart failure risk score after left ventricular assist device implantation

• Published in: Journal of cardiothoracic and vascular anesthesia 2022-10, Vol.36 (10), p.3740-3746
• Main Authors: Nicoara, Alina, Wright, Mary Cooter, Rosenkrans, Daniel, Patel, Chetan B., Schroder, Jacob N., Cherry, Anne D., Hashmi, Nazish K., Pollak, Angela L., McCartney, Sharon L., Katz, Jason, Milano, Carmelo A., Podgoreanu, Mihai V.
• Format: Article
• Language: English
• Subjects: Left ventricular assist device; Prediction; Right heart failure; Risk score
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2022.06.022

The prediction of right heart failure (RHF) after left ventricular assist device (LVAD) implantation remains a challenge. Recently, risk scores were derived from analysis of the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) data, the EUROMACS-RHF, and the modified postoperative EUROMACS-RHF. The authors assessed the performance characteristics of these 2 risk score formulations in a continuous-flow LVAD cohort at their institution. A retrospective, observational study. At a tertiary-care academic medical center. Adult patients who underwent durable LVAD implantation between 2015 and 2018. None Early post-LVAD RHF was defined as follows: (1) need for right ventricular assist device, or (2) inotropic or inhaled pulmonary vasodilator support for ≥14 postoperative days. The authors used logistic regression and examined receiver operating characteristic (ROC) curves to evaluate the ability of the 2 risk scores to distinguish between outcome groups. A total of 207 patients met the inclusion criteria. Of the patients, 16% developed RHF (33/207). The EUROMACS-RHF score was not predictive of RHF in the authors' cohort (odds ratio [OR] 1.25; 95% CI [0.99-1.60]; p = 0.06), but the postoperative EUROMACS-RHF CPB score was significantly associated (OR 1.38; 95% CI [1.03-1.89]; p = 0.03). The scores had similar ROC curves, with weak discriminatory performance: 0.601 (95% CI [0.509-0.692]) and 0.599 (95% CI [0.505-0.693]) for EUROMACS-RHF and postoperative EUROMACS-RHF, respectively. In the authors' single-center retrospective analysis, the EUROMACS-RHF risk score did not predict early RHF. An optimized risk score for the prediction of RHF after LVAD implantation remains an urgent unmet need.