P820 Echocardiographic assessment of late-onset right ventricular dysfunction following continuous-flow left ventricular assist device

Abstract Early right ventricular failure (RVF) remains one of the main factors associated with early mortality following continuous-flow left ventricular assist device (LVAD) implantation. However, late-onset RVF (LoRVF) has emerged as an increasing concern, but little is known about its incidence rate and the value of transthoracic echocardiography (TTE) to predict this complication during the LVAD follow-up. Methods and results We retrospectively analyzed the 1-year hemodynamic and clinical data from patients (p) that, between 2016 and 2018, underwent a right heart catheterization (RHC) after LVAD as bridge to transplantation (BTT). 73 p (84% males, 52 ± 12 years, 49% Heart Ware LVAD, 51% Heart Mate 3 LVAD), out of 187 LVAD implants, were studied. According to the Intermacs definition, LoRVF was assigned if the RHC showed a central venous pressure (CVP)>18 mmHg with cardiac index< 2.3 L/min/m2. Isolated LoRVF was assigned if LoRVF was present in the absence of elevated pulmonary capillary wedge pressure (PCWP) ≤15 mmHg. TTE was performed at the time of the RHC and the following parameters were obtained: parasternal long-axis left ventricular end diastolic diameter (LVEDD), basal (RVED1) and mid-cavity (EDRV2) end diastolic RV linear dimension in 4 chamber view, severity of tricuspid regurgitation (TR) and of mitral regurgitation (MR), tricuspid annular plane systolic excursion (TAPSE), and the position of the LVAD inflow cannula (IC). LoRVF was present in 16 p (22% of the studied population): 12 p (75%) presented a PCWP > 15 mmHg and 4 p (25%) presented isolated LoRVF. Symptoms and signs of venous congestion were present in 2/3 of the p with LoRVF and elevated PCWP. On the other hand, all the p with isolated LoRVF presented severe signs of venous congestion, and 50% of them could be successfully transplanted in high urgent status. P with LoRVF showed more dilated RV (RVED1 43.8 ± 9.2 vs 37.7 ± 5.3 mm, p = 0.02) and lower TAPSE (11 ± 2 vs 14 ± 2 mm p < 0.01) than the no LoRVF group. RVED1 showed a weak significant correlation with CVP (R = 0.3, p = 0.02). On the other hand, the presence of an elevated PCWP was not related to etiology of the cardiomyopathy, type and speed of LVAD, position of the IC, LVEDD, nor the presence of MR > mild. Conclusion LoRVF is a frequent complication during LVAD support as BTT and most of the cases are associated with persistent elevated PCWP. Isolated LoRVF, which is not associated with high PCWP, has a bad prognosis. RV evaluation with TTE during the clinical follow-up can be useful to detect LoRVF. However a persistent elevated PCWP is not associated with echocardiographic signs of incomplete unloading of the LV by the LVAD.