Validation of clinical scores for right ventricular failure prediction after implantation of continuous-flow left ventricular assist devices

Andreas P. Kalogeropoulos, Anita Kelkar, Jeremy F. Weinberger, Alanna A. Morris, Vasiliki V. Georgiopoulou, David W. Markham, Javed Butler, J. David Vega, Andrew L. Smith

Research output: Contribution to journalArticle

51 Scopus citations

Abstract

Background Several clinical prediction schemes for right ventricular failure (RVF) risk after left ventricular assist device (LVAD) implantation have been developed in both the pulsatile- and continuous-flow LVAD eras. The performance of these models has not been evaluated systematically in a continuous-flow LVAD cohort. Methods We evaluated 6 clinical RVF prediction models (Michigan, Penn, Utah, Kormos et al, CRITT, Pittsburgh Decision Tree) in 116 patients (age 51 ± 13 years; 41.4% white and 56.0% black; 66.4% men; 56.0% bridge to transplant, 37.1% destination therapy, 17.4% bridge to decision) who received a continuous-flow LVAD (HeartMate II: 79 patients, HeartWare: 37 patients) between 2008 and 2013. Results Overall, 37 patients (31.9%) developed RVF, defined: as pulmonary vasodilator use for ≥48 hours or inotrope use for ≥14 days post-operatively; re-institution of inotropes; multi-organ failure due to RVF; or need for mechanical RV support. Median (Quartile 1 to Quartile 3) time to initial discontinuation of inotropes was 6 (range 4 to 8) days. Among scores, the Michigan score reached significance for RVF prediction but discrimination was modest (C = 0.62 [95% CI 0.52 to 0.72], p = 0.021; positive predictive value [PPV] 60.0%; negative predictive value [NPV] 75.8%), followed by CRITT (C = 0.60 [95% CI 0.50 to 0.71], p = 0.059; PPV 40.5%; NPV 72.2%). Other models did not significantly discriminate RVF. The newer, INTERMACS 3.0 definition for RVF, which includes inotropic support beyond 7 days, was reached by 57 patients (49.1%). The Kormos model performed best with this definition (C = 0.62 [95% CI 0.54 to 0.71], p = 0.005; PPV 64.3%; NPV 59.5%), followed by Penn (C = 0.61), Michigan (C = 0.60) and CRITT (C = 0.60), but overall score performance was modest. Conclusion Current schemes for post-LVAD RVF risk prediction perform only modestly when applied to external populations.

Original languageEnglish (US)
Pages (from-to)1595-1603
Number of pages9
JournalJournal of Heart and Lung Transplantation
Volume34
Issue number12
DOIs
StatePublished - Dec 1 2015

Keywords

  • echocardiography
  • heart failure
  • left ventricular assist device
  • right ventricle failure
  • risk prediction model

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

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    Kalogeropoulos, A. P., Kelkar, A., Weinberger, J. F., Morris, A. A., Georgiopoulou, V. V., Markham, D. W., Butler, J., Vega, J. D., & Smith, A. L. (2015). Validation of clinical scores for right ventricular failure prediction after implantation of continuous-flow left ventricular assist devices. Journal of Heart and Lung Transplantation, 34(12), 1595-1603. https://doi.org/10.1016/j.healun.2015.05.005