ArticleThe Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation2024
Occult right ventricular dysfunction and right ventricular-vascular uncoupling in left ventricular assist device recipients.
Article in The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 16 citations in OpenAlex.
- Ventricular Strain Predicts the Risk of Right Heart Failure After Durable Left Ventricular Assist Device Implantation.JACC. Advances · 2026Article
- Right ventricular-pulmonary arterial coupling may discriminate late right heart failure outcomes in left ventricular assist device recipients.JHLT open · 2026Article
- Validation of the Hemodynamic Classification System for Hemodynamic-Related Events in Patients With Durable Left Ventricular Assist Devices.Journal of the American Heart Association · 2025Article
- Right Atrial Pressure/Pulmonary Capillary Wedge Pressure Ratio Predicts In-Hospital Mortality in Left Ventricular Assist Device Recipients.Journal of clinical medicine · 2025Article
- Right heart failure after left ventricular assist device implantation: latest insights and knowledge gaps on mechanism and prediction.Frontiers in cardiovascular medicine · 2025Review
- Non-invasive surrogates for right Ventricular-Pulmonary arterial coupling: a systematic review and Meta-Analysis.Pulmonary circulation · 2024Article
- Biventricular catheterization combined with pressure-volume loop monitoring provides insight into the dynamic effects of left ventricular assist devices ramp on right ventricular function.Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2024Article
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Authors and funding
15 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundDetecting right heart failure post left ventricular assist device (LVAD) is challenging. Sensitive pressure-volume loop assessments of right ventricle (RV) contractility may improve our appreciation of post-LVAD RV dysfunction.
methodsThirteen LVAD patients and 20 reference (non-LVAD) subjects underwent comparison of echocardiographic, right heart cath hemodynamic, and pressure-volume loop-derived assessments of RV contractility using end-systolic elastance (Ees), RV afterload by effective arterial elastance (Ea), and RV-pulmonary arterial coupling (ratio of Ees/Ea).
resultsLVAD patients had lower RV Ees (0.20 ± 0.08 vs 0.30 ± 0.15 mm Hg/ml, p = 0.01) and lower RV Ees/Ea (0.37 ± 0.14 vs 1.20 ± 0.54, p < 0.001) versus reference subjects. Low RV Ees correlated with reduced RV septal strain, an indicator of septal contractility, in both the entire cohort (r = 0.68, p = 0.004) as well as the LVAD cohort itself (r = 0.78, p = 0.02). LVAD recipients with low RV Ees/Ea (below the median value) demonstrated more clinical heart failure (71% vs 17%, p = 0.048), driven by an inability to augment RV Ees (0.22 ± 0.11 vs 0.19 ± 0.02 mm Hg/ml, p = 0.95) to accommodate higher RV Ea (0.82 ± 0.38 vs 0.39 ± 0.08 mm Hg/ml, p = 0.002). Pulmonary artery pulsatility index (PAPi) best identified low baseline RV Ees/Ea (≤0.35) in LVAD patients ((area under the curve) AUC = 0.80); during the ramp study, change in PAPi also correlated with change in RV Ees/Ea (r = 0.58, p = 0.04).
conclusionsLVAD patients demonstrate occult intrinsic RV dysfunction. In the setting of excess RV afterload, LVAD patients lack the RV contractile reserve to maintain ventriculo-vascular coupling. Depression in RV contractility may be related to LVAD left ventricular unloading, which reduces septal contractility.
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