Francesco Castagna, Andrea Faini, Gianfranco Parati, Garrick Stewart, John Cockcroft, Ulrich Jorde, Mandeep R Mehra
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引用次数: 0
Abstract
Background: Contemporary left ventricular assist devices (LVADs) improve survival, yet residual heart failure (HF) remains despite optimized device support. The extent to which right ventricular (RV)-pulmonary artery (PA) interaction, measured by single-beat elastance-based indices, identifies residual risk is unknown.
Methods: We studied 70 adults implanted with HeartMate3 LVADs (2018-2022) who underwent pre-discharge right heart catheterization after echocardiographic and invasive LVAD optimization. Using a single-beat method, RV end-systolic elastance (Ees), PA effective arterial elastance (Ea), and the Ees:Ea ratio (RV-PA coupling) were derived from high-fidelity pressure waveforms. Associations between these indices and surrogates of residual HF (cardiac output [CO] at discharge, need for high-dose outpatient diuretics, and 3-month 6-minute walking distance [6MWD]) were evaluated using multivariable regressions.
Results: Despite optimized LVAD support, patients demonstrated preserved RV Ees (0.40 ± 0.19mmHg/ml), elevated PA Ea (0.54 ± 0.21 mmHg/ml) and reduced Ees:Ea ratio (0.78 ± 0.36), consistent with RV-PA uncoupling. Higher PA Ea independently associated with lower CO and greater likelihood of high-dose diuretic use, while impaired RV-PA coupling (lower Ees:Ea) was the only hemodynamic parameter associated with reduced 6MWD. Traditional RV indices, including PAPi and CVP-to-wedge ratio, were not associated with outcomes.
Conclusion: Single-beat RV-PA elastance metrics identify residual HF phenotypes in clinically optimized HM3 recipients not captured by standard right-sided indices. If prospectively validated, incorporating RV Ees, PA Ea ("flow obstruction") and Ees:Ea ("energy inefficiency") into pre-discharge assessment may be used to refine risk stratification and inform device-directed and pulmonary vascular interventions during LVAD.
期刊介绍：
The Journal of Heart and Lung Transplantation, the official publication of the International Society for Heart and Lung Transplantation, brings readers essential scholarly and timely information in the field of cardio-pulmonary transplantation, mechanical and biological support of the failing heart, advanced lung disease (including pulmonary vascular disease) and cell replacement therapy. Importantly, the journal also serves as a medium of communication of pre-clinical sciences in all these rapidly expanding areas.
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