Non-Invasive TAPSE/PASP Ratio is Not Predictive of Early Right Ventricular Failure Post LVAD Implantation

H. Shah, V. Maharaj, B. Kenny, Rajat Kalra, A. El Rafei, S. Duval, J. Schultz, R. Cogswell, M. Pritzker

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PURPOSE: Right ventricular failure (RVF) after LVAD implantation remains difficult to predict. RV-PA coupling assessed by echocardiographic assessment of the ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) has shown to be prognostic in pulmonary hypertension and HFpEF. However, its utility in predicting RV failure after LVAD implantation has not been studied. We hypothesized that a low TAPSE/PASP ratio would be predictive of RV failure after LVAD. METHODS: This was a single center retrospective observational study of patients who had first-time continuous flow LVAD implantation between 2012-2018. Pre-implant transthoracic echocardiograms were reviewed for each patient to obtain TAPSE and PASP. The primary outcome was early right ventricular failure defined as need for RVAD, inotrope duration >14 days, and/or pulmonary vasodilator use >48 hours. Differences between definition groups were assessed with two sample t-test. Results are reported as means with standard deviations. RESULTS: 254 patients were initially included in the LVAD cohort. Of those, 159 patients had complete echocardiogram data to calculate a TAPSE/PASP ratio. 40 patients (25%) had postoperative RV failure after LVAD implantation, of which 8 (25%) required RVAD. There was no difference in the TAPSE/PASP ratio in the RV failure cohort compared to the non-RV failure cohort (0.36 ± 0.14 versus 0.38 ± 0.18, respectively). However, there was a significant difference in pre-operative TAPSE/PASP ratio in patients who required RVAD compared to patients who did not require RVAD post-operatively (0.52 ± 0.17 versus 0.36 ± 0.14, respectively; p = 0.015). When restricting the definition of RV failure to need for RVAD or inotropes >14 days, there was no difference in the TASPE/PASP ratio between groups (p=0.77). In addition, a lower TAPSE/PASP ratio was associated with higher RA pressure (r= -0.27) and PVR (r= -0.28); however, there was no association between TAPSE/PASP and cardiac output. CONCLUSION: In a single center cohort of continuous flow LVAD patients, TAPSE/PASP as a surrogate for RV-PA coupling is not predictive of early RV failure post LVAD implantation. However, a higher ratio was associated with the need for RVAD. Further study is needed to determine if other metrics assessing RV/PA coupling are predictive of RV failure.

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