Prediction of in-hospital mortality in left ventricular assist device recipients
O Karaca, B Keskin, A Akhundova, D Shahini, U SavurAbstract
Background/Introduction
Right ventricular failure (RVF) is a major contributor to early mortality after left ventricular assist device (LVAD) implantation. While various markers of right ventricular function and right ventriculoarterial coupling have been proposed, their value in predicting in-hospital mortality remains unclear.
Purpose
This study aimed to investigate the prognostic significance of the right atrial pressure/pulmonary capillary wedge pressure (RAP/PCWP) ratio—a surrogate of RV-Pulmonary artery (PA) coupling—for in-hospital mortality following LVAD implantation.
Methods
This retrospective single-center study included 44 patients who underwent LVAD implantation. Preoperative clinical, echocardiographic, and invasive hemodynamic parameters were collected. The optimal RAP/PCWP ratio cut-off was determined using receiver operating characteristic (ROC) analysis. Predictors of in-hospital mortality were assessed using univariate and multivariate logistic regression.
Results
Patients were stratified into high (≥0.47) and low (<0.47) RAP/PCWP ratio groups. In-hospital mortality was significantly higher in the high RAP/PCWP group (46% vs 10%, p=0.020). The optimal cut-off for the RAP/PCWP ratio was 0.47 (AUC: 0.829). In multivariate analysis, RAP/PCWP ratio (OR: 3.48 per 0.1 increase, p=0.020) and INTERMACS 1–2 profile (OR: 39.19, p=0.026) were independent predictors of in-hospital mortality.
Conclusions
Preoperative RAP/PCWP ratio, as a surrogate of right ventriculoarterial coupling, independently predicts in-hospital mortality following LVAD implantation. Its incorporation into preoperative assessment may enhance risk stratification and guide clinical management in this high-risk population.Graphical abstractFor image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.