Diastolic Pulmonary Gradient as a Predictor of Right Ventricular Failure After Left Ventricular Assist Device Implantation

Alnsasra, Hilmi; Asleh, Rabea; Schettle, Sarah; Pereira, Naveen L.; Frantz, Robert P.; Edwards, Brooks S.; Clavell, Alfredo L.; Maltais, Simon; Daly, Richard C.; Stulak, John M.; Rosenbaum, Andrew; Behfar, Atta; Kushwaha, Sudhir S.

doi:10.1161/jaha.119.012073

Cited by 21 publications

(15 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, CpcPH itself may be a risk factor for worse outcome post-LVAD implantation because high PVR and DPG were found to be associated with increased risk of right ventricular (RV) failure and death. 14 …”

Section: The Problemmentioning

confidence: 99%

Management of Pulmonary Hypertension in Left Heart Disease

Macera

Vachiéry

2021

Methodist DeBakey Cardiovascular Journal

View full text Add to dashboard Cite

Pulmonary hypertension due to left heart diseases (PH-LHD) is the most prevalent form of pulmonary hypertension. It frequently complicates heart failure with reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF) and negatively impacts prognosis, particularly when a precapillary component is present. PH-LHD is distinctive from pulmonary arterial hypertension (PAH) even though both conditions may share some common characteristics. In addition, the mechanisms involved in the development of a precapillary component are yet to be fully clarified, in particular in PH due to HFpEF. Several studies have been exploring PAH pathways as potential therapies for PH-LHD, but no PAH-approved drug has demonstrated efficacy in PH-LHD. Rather, some classes of drugs, such as endothelin-receptor antagonists or prostacycline-analogues, have been found to be harmful in patients with HF. Therefore, at present, the only established treatments for PH-LHD are those that target the heart as recommended in the international guidelines for HF. Based on current knowledge, off-label prescription of PAH-approved drugs in PH-LHD patients must be strongly discouraged.

show abstract

Section: The Problemmentioning

confidence: 99%

Management of Pulmonary Hypertension in Left Heart Disease

Macera

Vachiéry

2021

Methodist DeBakey Cardiovascular Journal

View full text Add to dashboard Cite

show abstract

“…Transpulmonary gradient (diastolic and/or mean) and corresponding pulmonary resistance are surrogates for right ventricular afterload and determine if a patient is eligible for transplant. They might also predict the risk for postoperative RHF and/or mortality in LVAD recipients [20]. LVAD therapy might be able to qualify patients for transplant who were not eligible due to preliminary existing pulmonary hypertension by lowering pulmonary artery pressure.…”

Section: Discussionmentioning

confidence: 99%

Right heart failure before LVAD implantation predicts right heart failure after LVAD implantation – is it that easy?

Wagner¹,

Bernhardt²,

Magnussen

et al. 2020

J Cardiothorac Surg

View full text Add to dashboard Cite

Background: Right heart failure (RHF) after left ventricular assist device (LVAD) implantation is common and associated with worse outcome. Prediction of RHF remains challenging. Our study aims to assess predictors of RHF focusing on clinical manifestations. Methods: We retrospectively analyzed clinical, echocardiographic and hemodynamic parameters of 112 patients undergoing LVAD implantation. Pre-operative, early (ERHF, day 7 and 14) and late postoperative RHF (LRHF, after 1, 3, 6 and 12 months) were assessed. Results: In the total study population (87.5% men, mean age 55 years), early RHF was frequent (47% on day 7 and 30% on day 14). Prevalence of late RHF and death from RHF was high after 3, 6 and 12 months (23, 24 and 17%). Pre-existing RHF was only associated with early RHF and persistent, but not for new onset late RHF. Early RHF was associated with lower INTERMACS level (p < 0.001), higher pulmonary vascular resistance (p = 0.046) and CVP/PAWP quotient (p = 0.011), higher bilirubin (p = 0.038) and creatinine (p = 0.013). LRHF was associated with creatinine (p = 0.006), urea (p = 0.012) and load adaption index (p = 0.007). Binary logistic regression models identified no single risk factors. Comparing the predictive value of regression models with a model of three clinical findings (INTERMACS level, age and pre-operative RHF) did not reveal differences in RHF. Conclusions: RHF before LVAD implantation enhances the risk of early RHF and persistent late RHF, but not for new onset late RHF, supporting the hypothesis of differences in the etiology. Echocardiographic or hemodynamic parameters did not show a predictive value for new onset late RHF. Similar predictive value of clinical findings and statistic models of risk factors suggest that a clinical evaluation is equally matched to predict RHF.

show abstract

“…Regardless of preimplantation PVR: low (< 5 WU) or high (≥ 5 WU), a 3-year survival after transplantation is similar between groups (85.0% and 79.0%, respectively), however posttransplant in-hospital mortality remains significantly increased among patients with the initially high PVR (P<0.05) [28]. Even PVR ≥3 WU vs. PVR < 3 WU places patients with HF and LVAD at higher risk of death (HR 1.55; P = 0.026), whereas elevated DPG is only associated with the development of RV failure (HR: 3.30; P = 0.004 for DPG ≥ 7 versus DPG < 7) [29].…”

Section: Pulmonary Hypertension Due To Left Heart Disease (Ph-2)mentioning

confidence: 99%

Diagnostic and Predictive Value of Right Heart Catheterization-Derived Measurements in Pulmonary Hypertension

2021

View full text Add to dashboard Cite

Right heart catheterization is a unique tool not only in the diagnosis but also in the management of patients with a wide range of cardiovascular diseases. The technique dates back to the 18th century, but the biggest advances were made in the 20th century. This review focuses on pulmonary hypertension for which right heart catheterization remains the diagnostic gold standard. Right heart catheterization-derived parameters help classify pulmonary hypertension into several subgroups, assess risk of adverse events or mortality and make therapeutic decisions. According to the European Society of Cardiology guidelines pulmonary hypertension (PH) is defined as an increase in mean pulmonary artery pressure (PAPm) > 25 mmHg, whereas a distinction between pre- and post-capillary PH is made based on levels of pulmonary artery wedge pressure (PAWP). Moreover, right atrial pressure (RAP), cardiac index (CI) and mixed venous oxygen saturation (SvO2) are the only parameters recommended to assess prognosis and only in patients with pulmonary arterial hypertension (PAH). Patients with RAP > 14 mmHg, CI < 2.0 l/min/m2 and SvO2 < 60% are at high (> 10%) risk of death within the next year. The purpose of this paper is to show that RHC-derived parameters can be used on a considerably larger scale than currently recommended. Several prognostic parameters, with specific thresholds have been identified for each subtype of pulmonary hypertension and can be helpful in everyday practice for treatment of PH.

show abstract

Diastolic Pulmonary Gradient as a Predictor of Right Ventricular Failure After Left Ventricular Assist Device Implantation

Cited by 21 publications

References 21 publications

Management of Pulmonary Hypertension in Left Heart Disease

Management of Pulmonary Hypertension in Left Heart Disease

Right heart failure before LVAD implantation predicts right heart failure after LVAD implantation – is it that easy?

Diagnostic and Predictive Value of Right Heart Catheterization-Derived Measurements in Pulmonary Hypertension

Contact Info

Product

Resources

About