External Validation and Comparison of the EUROMACS and Right Ventricular Failure Risk Score for Right Ventricular Failure Prediction after Left Ventricular Assist Device

S. Kumar, M. Rivas-Lasarte, S. M. Rashid, A. Scatola, Y. Rochlani, S. Murthy, O. Saeed, P. Chavez, S. J. Forest, J. J. Shin, S. R. Patel, S. Vukelic, D. Goldstein, U. P. Jorde, D. B. Sims

Research output: Contribution to journalArticle

Abstract

PURPOSE: To date, most scores derived to predict early RVF after LVAD implantation lack external validation. The aim of our study was to validate and compare the EUROMACS risk score and the right ventricular failure risk score (RVFRS). METHODS: From 1/2007 to 12/2017, 268 continuous-flow LVADs were implanted at Montefiore's Medical Center. We calculated both the EUROMACS score and the RVFRS and their predictive performance for early RVF defined as need for short- or long-term right-sided circulatory support, continuous inotropic support for ≥14 days, or nitric oxide ventilation for ≥48 hours post-operatively. RESULTS: RVF occurred in 100 patients (37%). Demographic characteristics were similar among patients, but RVF patients had higher baseline levels of AST and bilirubin, higher right atrial pressure, lower PAPi and more echocardiographic RV dysfunction (p<0.05). Regarding surgical management, RVF patients had higher cardiopulmonary bypass (CPB) time and more transfusions (p<0.001). Length of stay and intra-hospital mortality were higher in patients developing RVF. Area under the ROC curve of the EUROMACS score was 0.666 and for the RVFRS was 0.614 (p=0.186) (Fig. A). Decision curve analysis showed a slight net benefit applying both scores when the predicted probability of RVF is between 30 and 55% (Fig. B). Calibration was correct for both scores (non-significant Hosmer-Lemeshow test). CONCLUSION: In an external validation cohort, both the EUROMACS and RVFRS can predict RVF after LVAD. However, the clinical utility of these scores is limited.

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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