Predictors to Help Avoid RV Failure After LVAD Implantation

Pacemaker and heart pump. X-ray of the chest of a patient who is waiting for a heart and lung transplant. They have a pacemaker and a left ventricular assist device (LVAD) fitted. The left ventricle is the main pumping chamber of the heart, responsible for the circulation of oxygenated blood through the body. When it stops working properly, an LVAD is temporarily implanted to assist blood circulation. A pacemaker is a device that supplies electrical impulses to a malfunctioning heart so that it beats normally.
Researchers sought to identify parameters that could help predict the onset of right ventricular (RV) failure after left ventricular assist device (LVAD) implantation.

The strongest independent predictor of right ventricular (RV) failure following left ventricular assist device (LVAD) implantation was found to be free wall right ventricular longitudinal strain (fw-RVLS), according to a single-center prospective study published in The International Journal of Cardiovascular Imaging.

Researchers at the University of Siena in Italy enrolled patients in the study, who underwent implantation of a continuous flow LVAD between 2009 and 2019. Prior to surgery, patients were assessed for clinical, laboratory, and hemodynamic features and underwent an echocardiography. Instances of postoperative RV failure were related with potential biochemical, hemodynamic, and echocardiographic predictors of the adverse outcome.

The patient population comprised 8% women with a mean age of 63.08±2.83 years; 55% had ischemic heart failure, and the most common indication for LVAD implantation was destination therapy (71%).

A total of 8 patients presented with RV failure, which was associated with increased mortality (hazard ratio [HR], 3.42; 95% CI, 1.41-8.16; P =.01). Only 1 of those patients with RV failure survived up to 3 years (P =.003).

The patients who presented with RV failure had a longer stay in the intensive care unit (mean, 27 vs 11 days; P =.002); higher N-terminal pro-B-type natriuretic peptide levels (NT-proBNP; mean, 10,496.13 vs 2979.04 pg/ml; P =.006), right arterial pressure (mean, 17.23 vs 8.07 mm Hg; P =.007), fw-RVLS (-7.9% vs -15.99%; P =.009), and right arterial pressure to pulmonary capillary wedge pressure ratio (mean, 0.82 vs 0.45; P =.01); and lower tricuspid annular plane systolic excursion (mean, 11.88 vs 16.52 mm; P =.002), pulmonary artery pulsatility index (PAPi; mean, 1.52 vs 3.95; P =.003), and RV fractional area change (34.63% vs 40.59%; P =.04).

In the final model, the best predictors for RV failure were fw-RVLS, NT-proBNP, and PAPi (area under the curve [AUC], >0.80). After correcting for the 3 significant predictors, only fw-RVLS remained significant as an independent predictor for RV failure (P =.0065).

This study was limited by its small sample size, making the researchers unable to assess for fw-RVLS risk cutoffs.

The study authors concluded that fw-RVLS was the most meaningful predictor for RV failure risk following continuous flow LVAD implantation.

“The results of our study confirm that RV [failure] has a great impact on survival post-LVAD implantation, which highlights the necessity for having reliable predictors to best avoid this complication,” the researchers said.


Stricagnoli M, Sciaccaluga C, Mandoli GE, et al. Clinical, echocardiographic and hemodynamic predictors of right heart failure after LVAD placement. Int J Cardiovasc Imaging. Published online October 18, 2021. doi:10.1007/s10554-021-02433-7