Tricuspid annular plane systolic excursion/pulmonary vascular resistance index predicts right ventricular assist device requirement and mortality after magnetically levitated centrifugal-flow left ventricular assist device implantation.
4 affiliations
- 1Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.
- 2Department of Cardiovascular Diseases and Cardiovascular Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minn.
- 3Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
- 4Department of Cardiothoracic Surgery, Baptist Health, Little Rock, Alaska.
Abstract
Objectives
Right ventricular failure remains a major cause of perioperative morbidity and early mortality after left ventricular assist device implantation. We evaluated whether a novel and readily available echocardiographic-hemodynamic surrogate of right ventricular pulmonary vascular coupling predicts right ventricular assist device requirement and survival after magnetically levitated centrifugal flow left ventricular assist device.Methods
We performed a multicenter retrospective study of 202 HeartMate 3 recipients with preoperative right ventricular dysfunction. The tricuspid annular plane systolic excursion and pulmonary vascular resistance index ratio was derived. The primary end point was assessing its capacity to prognosticate the right ventricular assist device need in comparison with other established indices of right ventricular dysfunction. Multivariable logistic regression, calibration analysis, bootstrap validation, cross-validation, incremental-value modeling, and sensitivity analyses excluding venoarterial extracorporeal membrane oxygenation and mechanically ventilated patients were performed. Survival was assessed using Kaplan-Meier and Cox analyses.Results
The tricuspid annular plane systolic excursion and pulmonary vascular resistance index ratio demonstrated strong discrimination for right ventricular assist device requirement and outperformed conventional predictors. Bootstrap validation confirmed model stability, and cross-validation demonstrated consistent discrimination. Sensitivity analysis showed that discrimination remained robust after excluding venoarterial extracorporeal membrane oxygenation and mechanically ventilated patients. Multivariable logistic regression showed that the tricuspid annular plane systolic excursion and pulmonary vascular resistance index ratio remained independently associated with overall 1-year survival age, body mass index, chronic kidney disease, and diabetes. Discrimination remained robust after excluding venoarterial extracorporeal membrane oxygenation and venoarterial extracorporeal membrane oxygenation placement before the left ventricular assist device. A tricuspid annular plane systolic excursion and pulmonary vascular resistance index ratio threshold of 0.9 was able to stratify patient survival at 30 days, 100 days, and 1 year after left ventricular assist device placement.Conclusions
The tricuspid annular plane systolic excursion and pulmonary vascular resistance index ratio improves prediction of right ventricular assist device requirement and survival after HeartMate 3 implantation and may enhance perioperative right ventricular risk stratification.
Related
- Non-Cardiac Surgery After Left Ventricular Assist Device Implantation: Perioperative Management and Outcomes from a Single Center
- First-in-human totally robotic left ventricular assist device implantation through a right minithoracotomy
- Severe dynamic left-ventricular outflow-tract obstruction unmasked by transcatheter aortic valve implantation: a case report
- Early Right Heart Failure After Left Ventricular Assist Device Implantation: A Narrative Review of Definitions, Risk Prediction, and Management
- Prognostic value of pre- and post-procedural TAPSE/PASP ratio for long-term mortality in patients with left ventricular ejection fraction < 50% undergoing transcatheter aortic valve implantation
BibTeX
@article{crespodiaz2026tricuspid,
title = {{Tricuspid annular plane systolic excursion/pulmonary vascular resistance index predicts right ventricular assist device requirement and mortality after magnetically levitated centrifugal-flow left ventricular assist device implantation.}},
author = {Ruben Crespo-Diaz and Katarzyna Hryniewicz and Benjamin Sun and Peter M Eckman and Michael Samara and Alfredo Clavell and Barry A Boilson and Mauricio A Villavicencio and Phillip J Spencer and Karol Mudy and Sudhir S Kushwaha and Lisa M Mielniczuk and Robert P Frantz},
journal = {JTCVS open},
year = {2026},
month = aug,
doi = {10.1016/j.xjon.2026.102045},
url = {https://europepmc.org/article/MED/42948463},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Tricuspid annular plane systolic excursion/pulmonary vascular resistance index predicts right ventricular assist device requirement and mortality after magnetically levitated centrifugal-flow left ventricular assist device implantation.
AU - Ruben Crespo-Diaz
AU - Katarzyna Hryniewicz
AU - Benjamin Sun
AU - Peter M Eckman
AU - Michael Samara
AU - Alfredo Clavell
AU - Barry A Boilson
AU - Mauricio A Villavicencio
AU - Phillip J Spencer
AU - Karol Mudy
AU - Sudhir S Kushwaha
AU - Lisa M Mielniczuk
AU - Robert P Frantz
PY - 2026
DA - 2026/08/04
JO - JTCVS open
DO - 10.1016/j.xjon.2026.102045
UR - https://europepmc.org/article/MED/42948463
AB - Objectives Right ventricular failure remains a major cause of perioperative morbidity and early mortality after left ventricular assist device implantation. We evaluated whether a novel and readily available echocardiographic-hemodynamic surrogate of right ventricular pulmonary vascular coupling predicts right ventricular assist device requirement and survival after magnetically levitated centrifugal flow left ventricular assist device.Methods We performed a multicenter retrospective study of 202 HeartMate 3 recipients with preoperative right ventricular dysfunction. The tricuspid annular plane systolic excursion and pulmonary vascular resistance index ratio was derived. The primary end point was assessing its capacity to prognosticate the right ventricular assist device need in comparison with other established indices of right ventricular dysfunction. Multivariable logistic regression, calibration analysis, bootstrap validation, cross-validation, incremental-value modeling, and sensitivity analyses excluding venoarterial extracorporeal membrane oxygenation and mechanically ventilated patients were performed. Survival was assessed using Kaplan-Meier and Cox analyses.Results The tricuspid annular plane systolic excursion and pulmonary vascular resistance index ratio demonstrated strong discrimination for right ventricular assist device requirement and outperformed conventional predictors. Bootstrap validation confirmed model stability, and cross-validation demonstrated consistent discrimination. Sensitivity analysis showed that discrimination remained robust after excluding venoarterial extracorporeal membrane oxygenation and mechanically ventilated patients. Multivariable logistic regression showed that the tricuspid annular plane systolic excursion and pulmonary vascular resistance index ratio remained independently associated with overall 1-year survival age, body mass index, chronic kidney disease, and diabetes. Discrimination remained robust after excluding venoarterial extracorporeal membrane oxygenation and venoarterial extracorporeal membrane oxygenation placement before the left ventricular assist device. A tricuspid annular plane systolic excursion and pulmonary vascular resistance index ratio threshold of 0.9 was able to stratify patient survival at 30 days, 100 days, and 1 year after left ventricular assist device placement.Conclusions The tricuspid annular plane systolic excursion and pulmonary vascular resistance index ratio improves prediction of right ventricular assist device requirement and survival after HeartMate 3 implantation and may enhance perioperative right ventricular risk stratification.
SN - 2666-2736
ER -