Predictive Value of Noninvasive Right Ventricular to Pulmonary Artery Uncoupling for Right Ventricular Failure After Left Ventricular Assist Device Implantation

BACKGROUND: Although early right ventricular failure (eRVF) following durable left ventricular assist device (dLVAD) implantation is associated with a poor prognosis, reliable predictive parameters have not yet been established. In this study we evaluated the predictive value of right ventricular (RV) to pulmonary artery (PA) uncoupling, measured by the ratio of tricuspid annular plane systolic excursion (TAPSE) to PA systolic pressure (PASP), in patients undergoing dLVAD implantation. METHODS AND RESULTS: We conducted a single-center retrospective study of adult patients who underwent dLVAD implantation between January 2008 and December 2024. eRVF was defined as receiving short- or long-term right-sided circulatory support, or continuous inotropic support for more than 14 days within 30 days after dLVAD implantation. Preoperative echocardiographic variables, including the TAPSE/PASP ratio and right-sided heart catheter parameters, were analyzed using univariate and multivariate logistic regression models to identify eRVF predictors. We analyzed data for 111 patients who underwent dLVAD implantation and 46.8% developed eRVF postoperatively. The TAPSE/PASP ratio was an independent predictor of eRVF, even after adjustments for other echocardiographic variables (odds ratio [OR], 0.05; 95% confidence interval [CI], 0.004-0.67, P=0.024) and right-sided heart catheter variables (OR, 0.04; 95% CI, 0.002-0.69, P=0.027). CONCLUSIONS: Preoperative RV-PA uncoupling, assessed using the TAPSE/PASP ratio, may predict eRVF following dLVAD implantation. This parameter is clinically accessible and valuable for preoperative risk stratification and may facilitate improved perioperative management.