Right Ventriculoarterial Coupling Surrogates and Long-Term Survival in LVAD Recipients: Results of the ASSIST-ICD Multicentric Registry

IF 6.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Failure Pub Date : 2025-02-01 DOI:10.1016/j.cardfail.2024.05.007

MAXIME BENEYTO MD MS , RAPHAËL MARTINS MD, PhD , VINCENT GALAND MD , MICHEL KINDO MD, PhD , CLÉMENT SCHNEIDER MD , ALEXANDRE SEBESTYEN MD , AUDE BOIGNARD MD , LAURENT SEBBAG MD , MATTEO POZZI MD, PhD , THIBAUD GENET MD , THIERRY BOURGUIGNON MD , ANNE-CÉLINE MARTIN MD, PhD , PAUL ACHOUH MD, PhD , FABRICE VANHUYSE MD, PhD , HUGUES BLANG MD , CHARLES HENRI DAVID MD, PhD , MAGALI MICHEL MD , FRÉDÉRIC ANSELME MD, PhD , PIERRE-YVES LITZLER MD, PhD , MARIE JUNGLING MD , CLEMENT DELMAS MD, PhD

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引用次数: 0

Abstract

Background

Prediction of outcomes remains an unmet need in candidates for LVADs. The development of right-heart failure portends an excess in mortality rates, but imaging parameters of right ventricular systolic function have failed to demonstrate a prognostic role. By integrating pulmonary pressure, right ventriculoarterial coupling could fill this gap.

Methods

The ASSIST-ICD registry was used to test right ventriculoarterial coupling as a surrogate parameter at implantation for the prediction of all-cause mortality.

Results

The ratio of the tricuspid annular-plane systolic excursion over the estimated systolic pulmonary pressure (TAPSE/sPAP) was not associated with long-term survival in univariate analysis (P = 0.89), nor was the pulmonary artery pulsatility index (PAPi) (P = 0.13). Conversely, the ratio of the right atrial pressure over the pulmonary capillary wedge pressure (RAP/PCWP) was associated with all-cause mortality (P < 0.01). After taking tricuspid regurgitation severity, LVAD indication, LVAD model, age, blood urea nitrogen levels, and pulmonary vascular resistance into account, RAP/PCWP remained associated with survival (HR 1.35 [1.10 – 1.65]; P < 0.01).

Conclusion

Among pre-implant RVAC surrogates, only RAP/PCWP was associated with long-term all-cause mortality in LVAD recipients. This association was independent of established risk factors.

Abstract Image

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右心室-动脉耦合替代物与 LVAD 受者的长期生存：ASSIST-ICD 多中心登记的结果。

背景：对 LVAD 候选者的预后预测仍是一项尚未满足的需求。右心衰竭的发生预示着死亡率的升高，但右心室收缩功能的成像参数未能显示出预后作用。通过整合肺压、右心室-动脉耦合可以填补这一空白：方法：利用 ASSIST-ICD 登记测试植入时右心室-动脉耦合替代参数对全因死亡率的预测：在单变量分析中，三尖瓣环平面收缩期偏移与估计肺动脉收缩压之比（TAPSE/sPAP）与长期生存无关（P = 0.89），肺动脉搏动指数（PAPi）也与长期生存无关（P = 0.13）。相反，右心房压力与肺毛细血管楔压的比值（RAP/PCWP）与全因死亡率相关（p 结论：肺动脉搏动指数（PAPi）与长期生存率无关：在植入前 RVAC 代用指标中，只有 RAP/PCWP 与 LVAD 受者的长期全因死亡率相关。这种关联与既定的风险因素无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiac Failure 医学-心血管系统

CiteScore

7.80

自引率

8.30%

发文量

653

审稿时长

21 days

期刊介绍： Journal of Cardiac Failure publishes original, peer-reviewed communications of scientific excellence and review articles on clinical research, basic human studies, animal studies, and bench research with potential clinical applications to heart failure - pathogenesis, etiology, epidemiology, pathophysiological mechanisms, assessment, prevention, and treatment.