Combination evaluation of preoperative risk indices predicts requirement of biventricular assist device.

Abstract

BACKGROUND:

Patients with biventricular assist device (BiVAD) placement have a poor prognosis, but preoperative risk factors for the necessity of BiVAD have not been fully elucidated.

METHODS AND RESULTS:

Data from 79 patients who received left ventricular assist device (LVAD) between November 2002 and December 2011 were retrospectively reviewed. Overall, 9 patients (11.4%) required BiVAD, and the survival rate of BiVAD patients was significantly lower than that of LVAD patients (P<0.001). Multivariate analysis for BiVAD requirement showed left ventricular diastolic diameter (LVDd) ≤62 mm (odds ratio [OR], 10.97; P=0.009) to be significantly associated with BiVAD requirement. Preoperative central venous pressure (CVP)/pulmonary capillary wedge pressure (PCWP) ratio ≥0.5 (OR, 13.09; P=0.028) was also significantly associated with BiVAD requirement. A new scoring system for predicting BiVAD requirement was created from the combination of CVP/PCWP ratio (≥0.5), body surface area (≤1.4 m(2)), preoperative continuous hemodiafiltration use, B-type natriuretic peptide (≥1,200 pg/ml) and LVDd (≤62 mm), and this had a significantly larger area under the curve (0.909; P=0.003) than right ventricular stroke work index on receiver operating characteristic analysis. A score >20 using the new scoring method indicated significantly high probability of BiVAD requirement (OR, 16.00; P=0.019).

CONCLUSIONS:

The new scoring method, which includes CVP/PCWP ratio, is a novel risk stratification tool for BiVAD therapy.

• Authors: Taro Shiga, Koichiro Kinugawa, Teruhiko Imamura, Naoko Kato, Miyoko Endo, Toshiro Inaba, Hisataka Maki, Masaru Hatano, Atsushi Yao, Takashi Nishimura, Yasunobu Hirata, Shunei Kyo, Minoru Ono, Ryozo Nagai
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 76 Issue 12 Pg. 2785-91 ( 2012) ISSN: 1347-4820 [Electronic] Japan
• PMID: 22878403 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• Natriuretic Peptide, Brain

Topics

• Adult
• Biomarkers (blood)
• Body Surface Area
• Cardiac Resynchronization Therapy (adverse effects, mortality)
• Cardiac Resynchronization Therapy Devices
• Central Venous Pressure
• Decision Support Techniques
• Female
• Heart Failure (blood, diagnosis, mortality, physiopathology, therapy)
• Heart-Assist Devices
• Hemodiafiltration (adverse effects)
• Humans
• Japan (epidemiology)
• Kaplan-Meier Estimate
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Natriuretic Peptide, Brain (blood)
• Odds Ratio
• Pulmonary Wedge Pressure
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Time Factors
• Treatment Outcome
• Ventricular Function, Left
• Ventricular Function, Right