Predicting right ventricular failure after left ventricular assist device implant: A novel approach
Abstract Aims Right ventricular (RV) failure (RVF) after left ventricular assist device (LVAD) implant is an important cause of morbidity and mortality. Modern, data‐driven approaches for defining and predicting RVF have been under‐utilized. Methods Two hundred thirty‐two patients were identified wi...
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Wiley
2025-06-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.15200 |
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| author | Carissa E. Livingston Dale Kim Lacey Serletti Andrea Jin Sriram Rao Michael V. Genuardi Eliot G. Peyster |
| author_facet | Carissa E. Livingston Dale Kim Lacey Serletti Andrea Jin Sriram Rao Michael V. Genuardi Eliot G. Peyster |
| author_sort | Carissa E. Livingston |
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| description | Abstract Aims Right ventricular (RV) failure (RVF) after left ventricular assist device (LVAD) implant is an important cause of morbidity and mortality. Modern, data‐driven approaches for defining and predicting RVF have been under‐utilized. Methods Two hundred thirty‐two patients were identified with a mean age of 55 years; 40 (17%) were women, 132 were (59%) Caucasian and 74 (32%) were Black. Patients were split between Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Classes 1, 2 and 3 (25%, 38% and 34%, respectively). Within this group, ‘provisional RVF’ patients were identified, along with ‘no RVF’ patients. ‘No RVF’ patients were defined as patients who never demonstrated more than moderate RV dysfunction on a post‐LVAD transthoracic echocardiogram (TTE) (ordinal RV function <3), never required an RV assist device (RVAD), were not discharged on sildenafil and were not on a pulmonary vasodilator or inotropic medication at 3 months after LVAD implant. In total, n = 67 patients were defined as ‘no RVF’. The remaining patients represented the ‘provisional RVF’ population (n = 165). Extensive electronic health records queries yielded >1200 data points per patient. Using <1 and >1 month post‐LVAD time windows motivated by established, expert‐consensus definitions of ‘early’ and ‘late’ post‐implant RVF, unbiased clustering analysis was performed to identify hidden patient ‘phenogroups’ within these two established RVF populations. Clusters were compared on post‐implant clinical metrics and 1 year outcomes. Lastly, pre‐implant metrics were used to generate models for predicting post‐implant RVF phenogroup. Results Within the ‘early RVF’ time window, distinct ‘well’ and ‘sick’ patient phenogroup clusters were identified. These clusters had similar RV function and pulmonary vasodilator usage during the first month after LVAD but differed significantly in heart failure therapy tolerance, renal (P < 0.001) and hepatic (P = 0.013) function, RVAD usage (P = 0.001) and 1 year mortality (P = 0.047). Distinct ‘well’ and ‘sick’ phenogroups were also identified in the ‘late RVF’ time window. These clusters had similar RV function (P = 0.111) and RVAD proportions (P = 0.757) but differed significantly in heart failure medication tolerance, pulmonary vasodilator usage (P = 0.001) and 1 year mortality (P < 0.001). Prediction of phenogroup clusters from the ‘early RVF’ population achieved an area under the receiver operating characteristic curve (AUROC) of 0.84, with top predictors including renal function, liver function, heart rate and pre‐LVAD RV function. Conclusions Distinct, potentially predictable phenogroups of patients who have significantly different long‐term outcomes exist within consensus‐defined post‐LVAD RVF populations. |
| format | Article |
| id | doaj-art-7c57e72a46f34ecaa9cedcbf0d0837ad |
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| language | English |
| publishDate | 2025-06-01 |
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| series | ESC Heart Failure |
| spelling | doaj-art-7c57e72a46f34ecaa9cedcbf0d0837ad2025-08-20T03:11:21ZengWileyESC Heart Failure2055-58222025-06-011231916193110.1002/ehf2.15200Predicting right ventricular failure after left ventricular assist device implant: A novel approachCarissa E. Livingston0Dale Kim1Lacey Serletti2Andrea Jin3Sriram Rao4Michael V. Genuardi5Eliot G. Peyster6Department of Medicine, Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USADepartment of Bioengineering, School of Engineering and Applied Science University of Pennsylvania Philadelphia Pennsylvania USADepartment of Medicine, Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USAPerelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USAMonash University Victorian Heart Institute Melbourne Victoria AustraliaDivision of Cardiology, Department of Medicine Hospital of the University of Pennsylvania, Perelman School of Medicine Philadelphia Pennsylvania USADivision of Cardiology, Department of Medicine Hospital of the University of Pennsylvania, Perelman School of Medicine Philadelphia Pennsylvania USAAbstract Aims Right ventricular (RV) failure (RVF) after left ventricular assist device (LVAD) implant is an important cause of morbidity and mortality. Modern, data‐driven approaches for defining and predicting RVF have been under‐utilized. Methods Two hundred thirty‐two patients were identified with a mean age of 55 years; 40 (17%) were women, 132 were (59%) Caucasian and 74 (32%) were Black. Patients were split between Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Classes 1, 2 and 3 (25%, 38% and 34%, respectively). Within this group, ‘provisional RVF’ patients were identified, along with ‘no RVF’ patients. ‘No RVF’ patients were defined as patients who never demonstrated more than moderate RV dysfunction on a post‐LVAD transthoracic echocardiogram (TTE) (ordinal RV function <3), never required an RV assist device (RVAD), were not discharged on sildenafil and were not on a pulmonary vasodilator or inotropic medication at 3 months after LVAD implant. In total, n = 67 patients were defined as ‘no RVF’. The remaining patients represented the ‘provisional RVF’ population (n = 165). Extensive electronic health records queries yielded >1200 data points per patient. Using <1 and >1 month post‐LVAD time windows motivated by established, expert‐consensus definitions of ‘early’ and ‘late’ post‐implant RVF, unbiased clustering analysis was performed to identify hidden patient ‘phenogroups’ within these two established RVF populations. Clusters were compared on post‐implant clinical metrics and 1 year outcomes. Lastly, pre‐implant metrics were used to generate models for predicting post‐implant RVF phenogroup. Results Within the ‘early RVF’ time window, distinct ‘well’ and ‘sick’ patient phenogroup clusters were identified. These clusters had similar RV function and pulmonary vasodilator usage during the first month after LVAD but differed significantly in heart failure therapy tolerance, renal (P < 0.001) and hepatic (P = 0.013) function, RVAD usage (P = 0.001) and 1 year mortality (P = 0.047). Distinct ‘well’ and ‘sick’ phenogroups were also identified in the ‘late RVF’ time window. These clusters had similar RV function (P = 0.111) and RVAD proportions (P = 0.757) but differed significantly in heart failure medication tolerance, pulmonary vasodilator usage (P = 0.001) and 1 year mortality (P < 0.001). Prediction of phenogroup clusters from the ‘early RVF’ population achieved an area under the receiver operating characteristic curve (AUROC) of 0.84, with top predictors including renal function, liver function, heart rate and pre‐LVAD RV function. Conclusions Distinct, potentially predictable phenogroups of patients who have significantly different long‐term outcomes exist within consensus‐defined post‐LVAD RVF populations.https://doi.org/10.1002/ehf2.15200heart failureLVADright ventricleRVAD |
| spellingShingle | Carissa E. Livingston Dale Kim Lacey Serletti Andrea Jin Sriram Rao Michael V. Genuardi Eliot G. Peyster Predicting right ventricular failure after left ventricular assist device implant: A novel approach ESC Heart Failure heart failure LVAD right ventricle RVAD |
| title | Predicting right ventricular failure after left ventricular assist device implant: A novel approach |
| title_full | Predicting right ventricular failure after left ventricular assist device implant: A novel approach |
| title_fullStr | Predicting right ventricular failure after left ventricular assist device implant: A novel approach |
| title_full_unstemmed | Predicting right ventricular failure after left ventricular assist device implant: A novel approach |
| title_short | Predicting right ventricular failure after left ventricular assist device implant: A novel approach |
| title_sort | predicting right ventricular failure after left ventricular assist device implant a novel approach |
| topic | heart failure LVAD right ventricle RVAD |
| url | https://doi.org/10.1002/ehf2.15200 |
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