The right ventricular failure risk score - A pre-operative tool for assessing the risk of right ventricular failure in left ventricular assist device candidates
The right ventricular failure risk score - A pre-operative tool for assessing the risk of right ventricular failure in left ventricular assist device candidates
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DOI：
10.1016/j.jacc.2008.03.009
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发表时间：
2008-06-03
影响因子：
24
通讯作者：
Aaronson, Keith D.
中科院分区：
文献类型：
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作者：
Matthews, Jennifer Cowger;Koelling, Todd M.;Aaronson, Keith D.
目的本研究旨在建立一个模型，以评估左心室辅助装置（LVAD）候选者术后右心室（RV）衰竭的风险。背景LVAD手术后右心室衰竭与发病率和死亡率增加相关，但识别有RV衰竭风险的LVAD候选者仍然很困难。超声心动图和RV衰竭的血流动力学预测因素。右心室衰竭定义为术后需要静脉注射正性肌力药物支持> 14天，吸入一氧化氮>= 48小时，右侧循环支持，或出院时需要正性肌力药物。一个RV失败的风险评分（RVFRS），从多变量Logistic回归模型系数，和接收器操作特征曲线的得分generated.Results的197 LVAD植入，68（35%）并发症术后RV失败。需要血管加压药（4分）、天冬氨酸转氨酶≥ 80 IU/ l（2分）、胆红素≥ 2.0 mg/dl（2.5分）和肌酐≥ 2.3 mg/dl（3分）是RV衰竭的独立预测因素。RVFRS = 5.5的患者发生RV衰竭的比值比为0.49（95%置信区间[CI] 0.37 - 0.64），2.8（95% CI 1.4 - 5.9）和7.6（95% CI 3.4 - 17.1），180天生存率分别为90 +/-3%、80 +/-8%和66 +/-9%，（线性趋势的对数秩p = 0.0045）。RVFRS的受试者工作特征曲线下面积（0.73 ± 0.04）优于其他常用的RV衰竭预测因子（均p < 0.05）。结论RVFRS由常规收集的无创术前临床数据组成，可有效地对LVAD植入后RV衰竭和死亡的风险进行分层。
Objectives This study sought to develop a model that estimates the post-operative risk of right ventricular (RV) failure in left ventricular assist device (LVAD) candidates.Background Right ventricular failure after LVAD surgery is associated with increased morbidity and mortality, but identifying LVAD candidates at risk for RV failure remains difficult.Methods A prospectively collected LVAD database was evaluated for pre-operative clinical, laboratory, echocardiographic, and hemodynamic predictors of RV failure. Right ventricular failure was defined as the need for post-operative intravenous inotrope support for > 14 days, inhaled nitric oxide for >= 48 h, right-sided circulatory support, or hospital discharge on an inotrope. An RV failure risk score (RVFRS) was created from multivariable logistic regression model coefficients, and a receiver-operating characteristic curve of the score was generated.Results Of 197 LVADs implanted, 68 (35%) were complicated by post-operative RV failure. A vasopressor requirement (4 points), aspartate aminotransferase >= 80 IU/ l (2 points), bilirubin >= 2.0 mg/dl (2.5 points), and creatinine >= 2.3 mg/dl (3 points) were independent predictors of RV failure. The odds ratio for RV failure for patients with an RVFRS = 5.5 were 0.49 (95% confidence interval [CI] 0.37 to 0.64), 2.8 (95% CI 1.4 to 5.9), and 7.6 (95% CI 3.4 to 17.1), respectively, and 180-day survivals were 90 +/- 3%, 80 +/- 8%, and 66 +/- 9%, respectively (log rank for linear trend p = 0.0045). The area under the receiver-operating characteristic curve for the RVFRS (0.73 +/- 0.04) was superior to that of other commonly used predictors of RV failure (all p < 0.05).Conclusions The RVFRS, composed of routinely collected, noninvasive pre-operative clinical data, effectively stratifies the risk of RV failure and death after LVAD implantation.