Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Advanced Cardiac and Pulmonary Vascular Disease Programs, Jefferson University, Philadelphia, Pennsylvania, USA.
Cardiothoracic Surgery, University of Michigan, Ann Arbor, Michigan, USA.
J Am Coll Cardiol. 2021 Dec 7;78(23):2294-2308. doi: 10.1016/j.jacc.2021.09.1362.
A revised definition of right heart failure (RHF) for the Society of Thoracic Surgeons Intermacs database of left ventricular assist devices (LVADs) was introduced in June 2014.
The purpose of this study was to determine the prevalence and severity of RHF over time and the association of RHF status at 3 months with 12-month outcomes after LVAD.
All patients in Society of Thoracic Surgeons Intermacs with follow-up and supported at least 3 months with a continuous flow LVAD implanted between June 2, 2014 and March 31, 2017 without a simultaneous RVAD. RHF was defined as both documentation and manifestations of elevated central venous pressures.
There were 6,118 patients included with an incidence of RHF at 3, 6, and 12 months postimplant categorized as mild in 5%, 6%, and 6% and moderate in 5%, 3%, and 3%, respectively. For those with no RHF at 3 months, there was a low incidence of subsequent RHF at 6 and 12 months. The lack of RHF at 3 months, compared with mild and moderate RHF, was associated with a lower 12-month cumulative incidence of mortality (6.9% vs 16.7% vs 28.1%; P < 0.0001) and a lower 12-month cumulative incidence of stroke (7.4% vs 9.5% vs 11.0%; P = 0.0095), gastrointestinal bleeding (14.8% vs 24.2% vs 23.6%; P < 0.0001), and rehospitalization (65.2% vs 73.2% vs 71.2%; P < 0.0001).
In patients surviving 3 months with LVAD support alone, mild or moderate RHF occurred in nearly 1 of 10 patients at 12 months. Patients with late RHF had worse survival and a higher cumulative incidence of major adverse events.
2014 年 6 月，胸外科医师学会（STS）的左心室辅助装置（LVAD）Intermacs 数据库引入了右心衰竭（RHF）的修订定义。
本研究旨在确定 RHF 的患病率和严重程度随时间的变化情况，以及 3 个月时 RHF 状态与 LVAD 后 12 个月的结局之间的关联。
STS Intermacs 数据库中所有接受随访且至少 3 个月内接受连续血流 LVAD 植入的患者，这些患者于 2014 年 6 月 2 日至 2017 年 3 月 31 日之间接受治疗，且未同时接受 RVAD 治疗。RHF 的定义为中心静脉压升高的既有记录又有临床表现。
共纳入 6118 例患者，3、6 和 12 个月时 RHF 的发生率分别为轻度 5%、6%和 6%，中度 5%、3%和 3%。对于 3 个月时无 RHF 的患者，6 个月和 12 个月时后续发生 RHF 的发生率较低。与轻度和中度 RHF 相比，3 个月时无 RHF 与 12 个月时死亡率（6.9%比 16.7%比 28.1%；P<0.0001）和 12 个月时卒中（7.4%比 9.5%比 11.0%；P=0.0095）、胃肠道出血（14.8%比 24.2%比 23.6%；P<0.0001）和再住院（65.2%比 73.2%比 71.2%；P<0.0001）的 12 个月累积发生率较低相关。
在单独接受 LVAD 支持并存活 3 个月的患者中，10 例中有近 1 例在 12 个月时发生轻度或中度 RHF。出现晚期 RHF 的患者生存率更差，且主要不良事件的累积发生率更高。
