BACKGROUND Acute right heart failure (RHF) after left ventricular assist device implantation remains a major source of morbidity and mortality, yet the definition of RHF and the preimplant variables that predict RHF remain controversial. This study evaluated the ability of (1) INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) RHF classification to predict post-left ventricular assist device survival and (2) preoperative characteristics and hemodynamic parameters to predict severe and severe acute RHF. METHODS AND RESULTS An international, multicenter study at 4 large academic centers was conducted between 2008 and 2016. All subjects with hemodynamics measured by right heart catheterization within 30 days before left ventricular assist device implantation were included. RHF was defined using the INTERMACS definition for RHF. In total, 375 subjects were included (mean age, 57.4±13.2 years, 54% bridge-to-transplant). Mild RHF was most common (34%), followed by moderate RHF (16%), severe RHF (13%), and severe acute RHF (9%). Estimated on-device survival rates at 2 years were 72%, 71%, and 55% in the patients with none, mild-to-moderate, and severe-to-severe acute RHF, respectively (P=0.004). In addition, the independent hazard ratio for mortality was only increased in the patients with severe-to-severe acute RHF (hazard ratio, 3.95; 95% CI, 2.16-7.23; P<0.001). INTERMACS-defined RHF was superior to postimplant inotrope duration alone in the prediction of all-cause mortality. In multivariable analysis, older age, lower INTERMACS classes, and higher pulmonary arterial elastance (ratio of systolic pulmonary artery pressure to stroke volume) before left ventricular assist device, were identified as significant predictors of severe-to-severe acute RHF. Stratifying patients by ratio of systolic pulmonary artery pressure to stroke volume and right atrial pressure significantly improved the discrimination between patients at risk for severe-to-severe acute RHF. CONCLUSIONS The INTERMACS RHF classification correctly identifies patients at risk for mortality, though this risk is only increased in patients with severe-to-severe acute RHF. Several predictors for RHF were identified, of which ratio of systolic pulmonary artery pressure to stroke volume was the strongest hemodynamic predictor. Coupling ratio of systolic pulmonary artery pressure to stroke volume with right atrial pressure may be most helpful in identifying patients at risk for severe-to-severe acute RHF.

中文翻译：

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左心室辅助装置后的肺动脉弹性和INTERMACS定义的右心衰竭。

背景技术左心室辅助装置植入后的急性右心衰竭（RHF）仍然是发病率和死亡率的主要来源，但是RHF的定义和预测RHF的植入前变量仍存在争议。这项研究评估了（1）INTERMACS（机械辅助循环支持机构间注册表）RHF分类的能力，以预测左心室辅助装置的存活，以及（2）术前特征和血液动力学参数，以预测严重和严重急性RHF。方法与结果2008年至2016年之间，在4个大型学术中心进行了国际多中心研究。纳入了所有在左心辅助装置植入前30天内通过右心导管术测量血流动力学的受试者。使用针对RHF的INTERMACS定义来定义RHF。总共包括375名受试者（平均年龄，57.4±13.2岁，54％的桥对移植）。轻度RHF是最常见的（34％），其次是中度RHF（16％），重度RHF（13％）和重度急性RHF（9％）。无急性，轻度至中度和重度至重度急性RHF的患者在2年时的估计装置上存活率分别为72％，71％和55％（P = 0.004）。此外，仅在重度至重度急性RHF患者中增加了死亡率的独立危险比（危险比为3.95； 95％CI为2.16-7.23； P <0.001）。在全因死亡率的预测中，INTERMACS定义的RHF优于单独的植入后持续时间。在多变量分析中，年龄较大，INTERMACS类别较低，左心室辅助装置之前的较高肺动脉弹性（收缩期肺动脉压力与中风量的比）被认为是严重至严重急性RHF的重要预测指标。通过收缩期肺动脉压与中风量和右心房压之比对患者进行分层，可显着改善有严重至严重急性RHF风险的患者之间的区别。结论INTERMACS RHF分类正确地确定了有死亡风险的患者，尽管这种风险仅在严重至严重的急性RHF患者中增加。确定了几种RHF预测指标，其中收缩期肺动脉压与中风量的比值是最强的血液动力学预测指标。