The Right Ventricular-Arterial Compliance Index: A Novel Hemodynamic Marker to Predict Right Heart Failure Following Left Ventricular Assist Device

Ning Song; Sara L Hungerford; Sumita Barua; Katherine L Kearney; Kavitha Muthiah; Christopher S Hayward; David W M Muller; Audrey I Adji

doi:10.1097/MAT.0000000000002280

The Right Ventricular-Arterial Compliance Index: A Novel Hemodynamic Marker to Predict Right Heart Failure Following Left Ventricular Assist Device

ASAIO J. 2024 Sep 27. doi: 10.1097/MAT.0000000000002280. Online ahead of print.

Authors

Ning Song^{1

2}, Sara L Hungerford^{1

2

3

4}, Sumita Barua^{1

2

3}, Katherine L Kearney^{1

2

3}, Kavitha Muthiah^{1

2

3}, Christopher S Hayward^{1

2

3}, David W M Muller^{1

2}, Audrey I Adji^{1

2

3

5}

Affiliations

¹ From the Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia.
² Faculty of Health and Medicine, The University of New South Wales, Sydney, NSW, Australia.
³ Cardiac Mechanics Laboratory, Victor Chang Cardiac Research Institute, Sydney, NSW, Australia.
⁴ Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia.
⁵ Blood Pressure and Vascular Function Laboratory, Macquarie Medical School, Macquarie University, Sydney, NSW, Australia.

PMID: 39362188
DOI: 10.1097/MAT.0000000000002280

Abstract

The development of right heart failure (RHF) in patients with advanced heart failure following left ventricular assist device (LVAD) implantation remains difficult to predict. We proposed a novel composite hemodynamic index-the right ventricular-arterial compliance index (RVACi), derived from pulmonary artery pulse pressure (PAPP), ejection time (ET), heart rate (HR), and cardiac output (CO), with and expressed as mm Hg·s/L. We then conducted a retrospective, single-center analysis comparing the predictive value of RVACi for the development of RHF or unplanned right ventricular (RV) mechanical circulatory support following LVAD implantation against existing hemodynamic indices. One hundred patients were enrolled after screening 232 patients over a 10 year period, with 74 patients having complete hemodynamic data for RVACi calculation. There was good correlation between pulmonary arterial capacitance (R² = 0.48) and pulmonary vascular resistance (R² = 0.63) with RVACi, but not RV stroke work index or pulmonary artery pulsatility index. Reduced baseline RVACi (52 ± 23 vs. 92 ± 55 mm Hg·s/L; p = 0.02) was the strongest hemodynamic predictor of unplanned RV mechanical circulatory support requirement in patients following LVAD insertion. Composite pulsatile hemodynamic indices including RVACi may provide additional insight over existing hemodynamic indices for the prediction of RHF and need for RV mechanical circulatory support.