Background In patients with end-stage heart failure (HF), acute right heart failure (RHF) after left ventricular assist device (LVAD) implantation is known to be a source of significant morbidity and mortality. Previous data identified RV pulsatility load using pulmonary arterial compliance as a marker for 6-month mortality in LVAD patients. We aimed to test whether the right ventricular arterial elastance (RVEa) was associated with increased risk of 1 year mortality after LVAD implantation. Hypothesis Patients with higher RVEa at preimplantation have a higher risk of dying at 1 year. Methods We retrospectively identified 381 patients with complete pre-implant hemodynamics obtained Results The majority of patients (65%) had RVEa≥1 (Fig. 1). When comparing baseline demographics, those with RVEa ≥1 were younger, had a lower proportion of hypertension, coronary artery disease, and more likely to be on inotropes pre-implantation. Those with RVEa ≥1 had lower SV, and pulmonary artery pressure index; and higher mean pulmonary artery pressure, pulmonary wedge capillary pressure and transpulmonary gradient. Multivariate survival analysis adjusted for heart rate, BMI, age, and gender demonstrated the only independent predictor of mortality was RVEa ≥1 (hazard ratio 1.80, [95% CI 1.07 - 3.05], p= 0.028). Conclusions Our multi-institutional study demonstrates that higher RVEa is associated with increased 1 year mortality post-VAD implantation. These data may be generalizable to other academic institutions and warrants further investigation in larger cohorts.
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