Otten A, et al. - Researchers sought to examine the prognostic value of left ventricular (LV) and right ventricular (RV) volumes for early survival after Left ventricular assist device (LVAD) implantation by quantitatively assessing RV and LV volumes using 3D transoesophageal echocardiography and correlating the findings with clinical outcomes. In this study, patients with moderately increased end-diastolic RV volume index were observed to be at higher postoperative risk, however, severe RV dilatation seemed to be protective. In future, they recommended focusing postoperative management of patients with moderately dilated RVs on adjusting individually appropriate LVAD flows and providing frequent follow-up.

Methods

• A single-centre, non-randomized diagnostic cohort study was performed.
• Researchers used prospectively collected clinical and 3D echocardiographic data from 65 patients scheduled for LVAD implantation, using centrifugal pumps for long-term support (HeartWare and HeartMate 3).
• For this study, the primary end-point was 60-day mortality and the secondary end-point was longer term survival.

Results

• The cohort group was divided into survivors and non-survivors at 60 days [49 patients (75%) and 16 patients (25%), respectively].
• The 60-day non-survivors group showed significantly higher right to left end-diastolic ratio assessed by 2D echocardiography (0.70 ± 0.09 vs 0.62±0.11; P=0.01).
• The groups showed significant differences in terms of indexed end-diastolic volume parameters (LV, RV and overall heart); these were higher in the 60-day survivors group (LV volume 154±51 ml/m² vs 110±40 ml/m², P=0.004; RV volume 96±27 ml/m² vs 80±23 ml/m², P=0.05; heart 250 ± 64 ml/m² vs 190 ± 57 ml/m², P=0.003).
• In the logistic regression analysis, the right to left end-diastolic ratio and indexed RV end-diastolic volume were associated with 60-day mortality to investigate haemodynamic and echocardiographic parameters.
• For patients with indexed RV end-diastolic volume >82 ml/m² vs indexed RV end-diastolic volume ≤82 ml/m², the Kaplan–Meier survival curves showed better 1-year survival (P=0.005) for the group with more RV dilatation.