Introduction: Right ventricular dysfunction (RVD) prior to LVAD implantation has a negative impact on outcomes post implantation. Left to RV pre-ejection time (PEjT) greater than 40 ms is a marker of interventricular dyssynchrony and poor prognosis in patients with systolic heart failure (SHF). The prevalence of delayed RV PEjT compared to LV PEjT in SHF is not well-established. Further, it is not known whether this finding is associated with RVD measured by invasive hemodynamics.
Hypothesis: Delayed RV PEjT is associated with worse RVD and can predict early RV failure after LVAD implantation.
Methods: Right heart catheterization (RHC) hemodynamics and echocardiographic data performed less than 1 week apart were analyzed in a retrospective cohort of 57 consecutive patients with SHF who underwent LVAD implantation from 2011 to 2014. RV and LV PEjT were measured by pulsed wave Doppler. Primary outcome was early RV failure: need for post-operative IV inotropic support for >14 days, right sided circulatory support or death as result of RVF and RVD (CVP>15 mmHg) > 14 days.
Results: Results are outlined in the table below. A delayed RV PEjT was found in 50 % of patients with a median time of - 14 ms, despite no differences in QRS duration. RV function measured by TAPSE and fractional area change were similar in both groups. There was a significant association between delayed RV PEjT and worse 6-minute walk distance and RVD by invasive hemodynamics (higher CVP, lower RVSWI, lower PAPi). Five patients (8.7 %) after LVAD implantation developed RHF. Invasive hemodynamics or echocardiographic parameters were able to predict RHF after LVAD implantation.
Conclusion: In patients with advanced SHF waiting for LVAD, delayed RV PEjT is very prevalent and is associated with worse RVD. In our study, the incidence of RHF after LVAD implantation was small to predict early RHF. Further research is needed to determine whether RV pacing may potentially improve RV function by normalizing the RV to LV PEjT interval.