Right ventricular stroke work index as a negative predictor of mortality and initial hospital stay after lung transplantation

Hilary F. Armstrong, P. Christian Schulze, Tomoko S. Kato, Matthew Bacchetta, Wilawan Thirapatarapong, Matthew N. Bartels

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Studies have shown that patients with poor pre-lung transplant (LTx) right ventricular (RV) function have prolonged post-operative ventilation time and intensive care stay as well as a higher risk of in-hospital death. RV stroke work index (RVSWI) calculates RV workload and contractility. We hypothesized that patients with higher RV workload capacity, indicated by higher RVSWI, would have better outcomes after LTx. Methods: A retrospective record review was performed on all LTx patients between 2005 and 2011 who had right heart catheterizations (RHC) 1-year before LTx. In addition, results for echocardiograms and cardiopulmonary exercise testing within 1-year of RHCs were gathered. Results: Mean RVSWI was 9.36 ± 3.59 for 115 patients. There was a significant relation between mean pulmonary artery pressure (mPAP), RVSWI, RV end-diastolic diameter (RVEDd), left atrial dimension (LAD), peak and resting pressure of end-tidal carbon dioxide, minute ventilation /volume of carbon dioxide production, and 1-year mortality after LTx. Contrary to our hypothesis, those who survived had lower RVSWI than those who died within 1 year (8.99 ± 3.38 vs 11.6 ± 4.1, p = 0.026). Hospital length of stay significantly correlated with mPAP, RVSWI, left ventricular ejection fraction, percentage of fractional shortening, RVEDd, RV fractional area change, LAD, and RV wall thickness in diastole. Intensive care length of stay also significantly correlated with these variables and with body mass index. RVSWI was significantly different between groups of different RV function, indicating that increased RVSWI is associated with impairment of RV structure and function in patients undergoing LTx evaluation. Conclusions: This study demonstrates an association between 1-year mortality, initial hospital and intensive care length of stay, and pre-LTx RVSWI. Increased mPAP is a known risk for outcomes in LTx patients. Our findings support this fact and also show increased mortality with elevation of RVSWI, demonstrating the value of RV function in the assessment of risk for pre-LTx patients.

Original languageEnglish (US)
Pages (from-to)603-608
Number of pages6
JournalJournal of Heart and Lung Transplantation
Volume32
Issue number6
DOIs
StatePublished - Jun 2013
Externally publishedYes

Fingerprint

Lung Transplantation
Length of Stay
Stroke
Mortality
Right Ventricular Function
Critical Care
Pulmonary Artery
Pressure
Workload
Carbon Dioxide
Ventilation
Diastole
Cardiac Catheterization
Operative Time
Hospital Mortality
Stroke Volume
Body Mass Index
Exercise
Transplants
Lung

Keywords

  • cardiopulmonary exercise test
  • lung transplant
  • right heart catheterization
  • right ventricular function
  • right ventricular stroke work index

ASJC Scopus subject areas

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

Cite this

Right ventricular stroke work index as a negative predictor of mortality and initial hospital stay after lung transplantation. / Armstrong, Hilary F.; Christian Schulze, P.; Kato, Tomoko S.; Bacchetta, Matthew; Thirapatarapong, Wilawan; Bartels, Matthew N.

In: Journal of Heart and Lung Transplantation, Vol. 32, No. 6, 06.2013, p. 603-608.

Research output: Contribution to journalArticle

Armstrong, Hilary F. ; Christian Schulze, P. ; Kato, Tomoko S. ; Bacchetta, Matthew ; Thirapatarapong, Wilawan ; Bartels, Matthew N. / Right ventricular stroke work index as a negative predictor of mortality and initial hospital stay after lung transplantation. In: Journal of Heart and Lung Transplantation. 2013 ; Vol. 32, No. 6. pp. 603-608.
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AU - Armstrong, Hilary F.

AU - Christian Schulze, P.

AU - Kato, Tomoko S.

AU - Bacchetta, Matthew

AU - Thirapatarapong, Wilawan

AU - Bartels, Matthew N.

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N2 - Background: Studies have shown that patients with poor pre-lung transplant (LTx) right ventricular (RV) function have prolonged post-operative ventilation time and intensive care stay as well as a higher risk of in-hospital death. RV stroke work index (RVSWI) calculates RV workload and contractility. We hypothesized that patients with higher RV workload capacity, indicated by higher RVSWI, would have better outcomes after LTx. Methods: A retrospective record review was performed on all LTx patients between 2005 and 2011 who had right heart catheterizations (RHC) 1-year before LTx. In addition, results for echocardiograms and cardiopulmonary exercise testing within 1-year of RHCs were gathered. Results: Mean RVSWI was 9.36 ± 3.59 for 115 patients. There was a significant relation between mean pulmonary artery pressure (mPAP), RVSWI, RV end-diastolic diameter (RVEDd), left atrial dimension (LAD), peak and resting pressure of end-tidal carbon dioxide, minute ventilation /volume of carbon dioxide production, and 1-year mortality after LTx. Contrary to our hypothesis, those who survived had lower RVSWI than those who died within 1 year (8.99 ± 3.38 vs 11.6 ± 4.1, p = 0.026). Hospital length of stay significantly correlated with mPAP, RVSWI, left ventricular ejection fraction, percentage of fractional shortening, RVEDd, RV fractional area change, LAD, and RV wall thickness in diastole. Intensive care length of stay also significantly correlated with these variables and with body mass index. RVSWI was significantly different between groups of different RV function, indicating that increased RVSWI is associated with impairment of RV structure and function in patients undergoing LTx evaluation. Conclusions: This study demonstrates an association between 1-year mortality, initial hospital and intensive care length of stay, and pre-LTx RVSWI. Increased mPAP is a known risk for outcomes in LTx patients. Our findings support this fact and also show increased mortality with elevation of RVSWI, demonstrating the value of RV function in the assessment of risk for pre-LTx patients.

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