Pressure-Dimension Index and Left Ventricular Sphericity Index Following HeartMate II and HeartMate 3 implantation

ESC Heart Failure, vol. 11, pp. 3012–3022

Abstract

Abstract Aims This study aimed to compare the changes in the left ventricle (LV) and right ventricle (RV) geometry and performance after the implantation of HeartMate II (HMII) and HeartMate 3 (HM3). In addition, we investigated whether the echocardiographic parameters LV sphericity index (LVSI) and the novel pressure-dimension index (PDI) can predict post-operative right ventricular failure (RVF). Methods and results Between 2012 and 2020, 46 patients [HMII (n = 22) and HM3 (n = 24)] met the study's criteria and had echocardiography tests pre-operatively, 6 and 12 months post-operatively. The LVSI and PDI were calculated together with the standard LV and RV echocardiographic parameters. The mean follow-up was 24 ± 7 months. In both groups, the LV end-diastolic diameter (LVEDD) significantly decreased 12 months post-operatively compared with the pre-operative values (HMII: 6.4 ± 1.4 cm vs. 5.7 ± 0.9 cm, P = 0.040; HM3: 6.7 ± 1.3 cm vs. 5.5 ± 0.9 cm, P < 0.01, respectively). RV function 12 months post-operatively was better in the HM3 group than in the HMII group, as indicated by a significantly higher RV fractional area change (RVFAC) in the HM3 group than in the HMII group 12 months post-operatively (35 ± 12% vs. 26 ± 16%, P = 0.039), significantly higher tricuspid annular plane systolic excursion (TAPSE) in the HM3 group 12 months post-operatively compared with the HMII group (13.9 ± 1.9 mm vs. 12.0 ± 2.1 mm, P = 0.002), and the tissue Doppler estimated tricuspid annular systolic velocity (TASV) was also significantly higher in the HM3 group 12 months post-operatively compared with the HMII group (11.5 ± 2.7 mm/s vs. 9.9 ± 1.5 mm/s, P = 0.020). The LVSI value was significantly higher 12 months post-operatively in the HMII group than in the HM3 group (1.2 ± 0.4 vs. 0.8 ± 0.2, P = 0.001, respectively), indicating worse geometric changes. The PDI decreased 12 months post-operatively in the HM3-group compared with the baseline (3.4 ± 1.4 mmHg/cm2 vs. 2.0 ± 0.8 mmHg/cm2, P < 0.001). In the univariate and multivariate analyses, only the pre-operative PDI was a predictor of post-operative RVF [odds ratio: 3.84 (95% CI: 1.53–18.16, P = 0.022)]. The area under the curve for pre-operative PDI was 0.912. The 2 year survival was significantly better in the HM3 group (log-rank, P = 0.042). Conclusions The design of HM3 offered better geometrical preservation of the LV and enabled normal PDI values, leading to improved RV function, as indicated by better RVFAC, TAPSE, and TASV values. The use of pre-operative PDI as an additional tool for established risk scores might offer a better pre-operative predictor of RVF.

Authors 9

1. Luisa Schnoering Aachen Faculty of Medicine Department of Cardiac Surgery

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Department of Cardiac Surgery, Faculty of Medicine, RWTH University Hospital Aachen, RWTH Aachen University , Aachen ,

   Department of Cardiac Surgery, Faculty of Medicine, RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany

2. Mohammad Amen Khattab Aachen Faculty of Medicine Department of Cardiac Surgery

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Department of Cardiac Surgery, Faculty of Medicine, RWTH University Hospital Aachen, RWTH Aachen University , Aachen ,

   Department of Cardiac Surgery, Faculty of Medicine, RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany

3. Payam Akhyari Aachen Faculty of Medicine Department of Cardiac Surgery

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Department of Cardiac Surgery, Faculty of Medicine, RWTH University Hospital Aachen, RWTH Aachen University , Aachen ,

   Department of Cardiac Surgery, Faculty of Medicine, RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany

4. Ajay Kumar Moza Aachen Faculty of Medicine Department of Cardiac Surgery

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Department of Cardiac Surgery, Faculty of Medicine, RWTH University Hospital Aachen, RWTH Aachen University , Aachen ,

   Department of Cardiac Surgery, Faculty of Medicine, RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany

5. Assad Haneya

   Krankenhaus der Barmherzigen Brüder Trier

   Affiliation as printed

   Department of Cardiothoracic Surgery, Heart Centre Trier, Barmherzigen Brueder Hospital , Trier ,

   Department of Cardiothoracic Surgery, Heart Centre Trier, Barmherzigen Brueder Hospital, Trier, Germany

6. Abdel Hannan Diab

   Krankenhaus der Barmherzigen Brüder Trier

   Affiliation as printed

   Department of Cardiothoracic Surgery, Heart Centre Trier, Barmherzigen Brueder Hospital , Trier ,

   Department of Cardiothoracic Surgery, Heart Centre Trier, Barmherzigen Brueder Hospital, Trier, Germany

7. Ahmad Abugameh

   Krankenhaus der Barmherzigen Brüder Trier

   Affiliation as printed

   Department of Cardiothoracic Surgery, Heart Centre Trier, Barmherzigen Brueder Hospital , Trier ,

   Department of Cardiothoracic Surgery, Heart Centre Trier, Barmherzigen Brueder Hospital, Trier, Germany

8. Shahram Lotfi Aachen Faculty of Medicine Department of Cardiac Surgery

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Department of Cardiac Surgery, Faculty of Medicine, RWTH University Hospital Aachen, RWTH Aachen University , Aachen ,

   Department of Cardiac Surgery, Faculty of Medicine, RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany

9. Rashad Zayat corresponding Aachen Faculty of Medicine Department of Thoracic Surgery

   RWTH Aachen University · Universitätsklinikum Aachen · Krankenhaus der Barmherzigen Brüder Trier

   Affiliation as printed

   Department of Cardiothoracic Surgery, Heart Centre Trier, Barmherzigen Brueder Hospital , Trier ,

   Department of Thoracic Surgery, Faculty of Medicine, RWTH University Hospital Aachen, RWTH Aachen University , Aachen ,

   Department of Cardiothoracic Surgery, Heart Centre Trier, Barmherzigen Brueder Hospital, Trier, Germany

   Department of Thoracic Surgery, Faculty of Medicine, RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany