WASHINGTON — Measuring markers of inflammation and neurohumoral activation in candidates for implantation with a left ventricular assist device may help predict the probability of right ventricular failure, Evgenij V. Potapov, M.D., reported at the annual conference of the American Society for Artificial Internal Organs.
“The problem is that up to 20% of patients receiving a left ventricular assist device [LVAD] develop right heart failure,” Dr. Potapov, a cardiothoracic surgeon at the Deutsches Herzzentrum Berlin, said in an interview.
Dr. Potapov and his colleagues reviewed the records of patients with chronic end-stage heart failure who received an LVAD during 2002-2004.
They found no differences in preoperative echocardiographic findings or laboratory or hemodynamic parameters between the 102 patients who had normal right ventricular function after LVAD implantation and the 9 patients with right ventricular failure, defined as having at least two of the following within 24 hours of LVAD implantation: mean arterial pressure less than 55 mm Hg, central venous pressure less than 16 mm Hg, mixed venous oxygen saturation less than 55%, cardiac index less than 2 L/min per square meter, and more than 20 inotropic equivalents of inotropic support.
But a subsequent prospective study of 40 patients found that people with normal right ventricular function after left ventricular assist device implantation had significantly lower levels of markers of inflammation (procalcitonin and neopterin) and neurohumoral activation (N-terminal pro-B-type natriuretic peptide and big endothelin-1) than did those who would later develop right ventricular failure, he said in a poster session at the conference.
Patients who are identified as having a high probability of right ventricular failure after implantation of a left ventricular assist device could instead undergo implantation of a biventricular support device or a total artificial heart, Dr. Potapov suggested.
None of the patients who were in either study required a left ventricular assist device for postcardiotomy heart failure.