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Tricuspid annular motion as a predictor of severe right ventricular failure after left ventricular assist device implantation.

Authors
  • Puwanant, Sarinya1
  • Hamilton, Karen K
  • Klodell, Charles T
  • Hill, James A
  • Schofield, Richard S
  • Cleeton, Timothy S
  • Pauly, Daniel F
  • Aranda, Juan M Jr
  • 1 Division of Cardiovascular Medicine, Department of Internal Medicine, University of Florida, Gainesville, Florida, USA. [email protected]
Type
Published Article
Journal
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
Publication Date
Oct 01, 2008
Volume
27
Issue
10
Pages
1102–1107
Identifiers
DOI: 10.1016/j.healun.2008.07.022
PMID: 18926401
Source
Medline
Language
English
License
Unknown

Abstract

Right ventricular (RV) failure after left ventricular assist device (LVAD) implantation is associated with a high rate of morbidity and mortality. We sought to determine pre-operative right heart echocardiographic predictors of post-LVAD severe RV failure. RV failure, defined as the need for inotropic support or pulmonary vasodilators for >or=14 days post-operatively, was evaluated in 33 patients (age 54 +/- 13 years) with LVADs. Preoperative RV systolic and diastolic echocardiographic parameters, including RV fractional area change, tricuspid annular motion, right atrial volume index, RV index of myocardial performance, hepatic vein Doppler velocities, tricuspid regurgitation severity, and RV systolic pressures (RVSPs) in patients with and without RV failure were compared. Of the 33 patients evaluated, 11 (33%) had post-LVAD RV failure (2 needed RVAD support). Patients with post-LVAD RV failure had significantly lower pre-operative tricuspid annular motion (8 +/- 4 vs 15 +/- 6 mm, p < 0.01) and higher RVSPs (60 +/- 14 vs 46 +/- 11 mm Hg, p = 0.02). In 13 patients (39%) with moderate tricuspid regurgitation, pre-operative tricuspid annular motion remained significantly reduced (6.0 +/- 0.5 vs 13.5 +/- 5.0 mm, p = 0.045). Other echocardiographic parameters were not significantly different between patients. Tricuspid annular motion of <7.5 mm provides 91% specificity and 46% sensitivity in predicting post-LVAD RV failure. Tricuspid annular motion is a predictor of post-LVAD RV failure. Using tricuspid annular motion in addition to conventional criteria may aid in early identification of patients with prolonged inotropic support or severe RV failure and allow for better pre-operative planning.

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