Predicting Right Ventricular Failure Following Left Ventricular Assist Device Support: An INTERMACS Validation Study

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Introduction: : The Utah Right Ventricular Failure (RVF) Risk score is a 7-factor predictive model (African American, history of HTN, INTERMACS profile 1-2, Na <130mEq/L, BUN >35mg/dL, PA pulse pressure <36mmHg and RA/PCWP >0.5) that achieved a high discriminative performance (AUC 0.73) for predicting RVF in a three-center study of patients undergoing left ventricular assist device (LVAD) implantation and was validated in an external two-center cohort (AUC 0.71). Objective: : Validate a modified Utah RVF (mRVF) Risk score on a larger U.S. geographical scale. Methods: : INTERMACS data were requested for patients (age ≥19 years) undergoing isolated continuous flow LVAD implant between January 1, 2012 to through December 31, 2017. A modified (mRVF) score was computed without “history of hypertension” due to omission of variable on INTERMACS database. We excluded cases that were missing any of the 7-factor predictor variables. Primary outcome was early RVF, defined as the need for RVAD (BiVAD) support. Secondary outcomes were 90-day all-cause mortality. Multivariable logistic regression analysis was used to validate the predictive model. Results: : The study included 12550 (59.9%) INTERMACS cases that had all variables of the novel predictive model available. Of those cases, incidence of RVF was 3.37% with a median [25th, 75th] predictive mRVF score of 5 [3.38, 6.62]. In the patient population who did not have RVF post-LVAD implantation, their median [25th, 75th] predictive mRVF score was 4 [2.22, 5.78]. The novel predictive model had modest accuracy for predicting the risk of RVF post-LVAD implantation (AUC 0.678). The modified Utah RVF score was poorly predictive of 90-day mortality (area under the ROC curve 0.571). Conclusion: : The modified Utah RVF Risk score offered modest accuracy when applied to a large real world LVAD registry. Further studies examining the impact of unanticipated intra-operative and post-operative events on risk stratification are necessary.

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