Right Heart Failure
Conditions
Keywords
Right Heart Failure, Ventricular Assist Device, Mortality, ICU Stay, Acute Kidney Injury
Brief summary
The primary purpose of this study is to investigate the evolution of Right Ventricular (RV) function before and after left ventricular assist device (LVAD) implantation, using novel echocardiographic quantification of RV size and function in combination with comprehensive hemodynamic, laboratory and clinical parameters. The findings of the study will enhance prediction of early and late development of postoperative right-sided heart failure (RHF) and subsequent mortality and morbidity. The secondary purpose of the study is to combine echocardiographic, hemodynamic, laboratory, and clinical data to define optimal management strategies of RHF after LVAD implantation.
Detailed description
The study consists of 2 parts: a Pilot study and a Main Study as detailed below. The purpose of the Pilot study is to evaluate the feasibility of RV quantification using two-, three-dimensional and Multiplane echocardiography. About 100 subjects undergoing LVAD implantation in the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) Registry are included in the Pilot study. These 100 patients will undergo routinely scheduled echocardiography before, within 1 week, 3 months and 1 year after LVAD implantation. Echocardiography will be performed using ultrasound machines that are capable of acquisition of two-, three-dimensional and Multiplane Echocardiography of the right ventricle. Echocardiographic analysis will include three-dimensional quantification of the RV size and function as well as RV strain analysis in the Multiplane format as described in the Appendix Echocardiography Procedure Manual. The Echocardiographic analyses of the first 50 patients, included in selected sites, will be used to further specify the protocol for image acquisition and analysis to be used in the Main Study. Furthermore, all sites will first enter 2 patients in the Pilot Study before they can participate in the Main Study. The echocardiographic results of these 2 patients will be assessed by the core lab for quality. The purpose of the Main Study is to assess the evolution of RV function before and after LVAD implantation utilizing the acquisition and analysis protocol developed in the Pilot Study. 500 patients will undergo routinely scheduled echocardiographic imaging before LVAD implantation, and at 1 week, 1 month, 3 months, 6 months and 1 year thereafter. Echocardiography will be performed using the detailed protocol developed in the Pilot Study. All Echocardiographic images will be submitted to an independent Core Laboratory for analysis. The evolution of RV function will be documented with standardised two-, three-dimensional and Multiplane Echocardiography of the right ventricle. The echocardiographic parameters include: RV strain and strain rate, RV Fractional Area Change, RV longitudinal function, RV volumes, RV ejection fraction, tricuspid regurgitation severity, estimated pulmonary artery pressures, pulmonary artery resistance, pulmonary artery compliance, RV stroke work index, right atrial size, and RV - pulmonary coupling. Invasive hemodynamic data will be collected in the perioperative period. These RV parameters will be linked to the occurrence of clinical signs, hemodynamic and laboratory evidence of RHF.
Interventions
DIAGNOSTIC_TESTEchocardiography
Echocardiography
Sponsors
The European Association for Cardio-Thoracic Surgery
Erasmus Medical Center
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
17 Years to No maximum
Inclusion criteria
Subjects to be included in the study must meet the following inclusion criteria: 1. Consecutive patients accepted for elective LVAD implantation in the context of routine care 2. \>17 years of age 3. Written informed consent (IC), either by the patient or by legal representatives 4. Treated with mainstream devices
Exclusion criteria
* None
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Moderate or severe RHF | 12 months | RHF is defined by a triad of: 1. Clinical (right-sided congestion, with or without hypotension, or hypo-perfusion) 2. Imaging evidence (RV dilatation, new \> grade 2 tricuspid regurgitation) deterioration right ventricular function score assessed by the echocardiography core laboratory) 3. Hemodynamic evidence (discordant elevated central venous pressure (CVP) or right atrial pressure (RAP) \>16 mmHg, despite normal or steady pulmonary capillary wedge pressure (PCWP), or right atrial (RA) to PCWP ratio \>0.54). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| All-cause death | 1 week, 30 days, 90 days, 180 days, 12 months | The occurrence of all-cause death after LVAD implantation |
| Cardiovascular death | 1 week, 30 days, 90 days, 180 days, 12 months | The occurrence of cardiovascular death after LVAD implantation |
| Death or urgent transplantation | 1 week, 30 days, 90 days, 180 days, 12 months | The occurrence of death or urgent transplantation after LVAD implantation |
| Length of post-operative Intensive Care Unit (ICU) stay | 30 days, 90 days, 180 days, 12 months | The length of post-operative ICU stay in days after LVAD implantation |
| Length of post-operative hospital stay | 30 days, 90 days, 180 days, 12 months | The length of post-operative hospital stay in days after LVAD implantation |
| Readmissions for heart failure or RHF | 30 days, 90 days, 180 days, 12 months | The occurrence of hospital readmissions for heart failure or RHF after LVAD implantation |
| Sepsis | 1 week, 30 days, 90 days, 180 days, 12 months | The occurrence of sepsis after LVAD implantation |
| LVAD and driveline-related infection | 1 week, 30 days, 90 days, 180 days, 12 months | The occurrence of LVAD and driveline-related infection after LVAD implantation |
| Early and late bleeding complications | 1 week, 30 days, 90 days, 180 days, 12 months | The occurrence of LVAD and driveline-related infection after LVAD implantation |
| Severe RHF composite | 1 week, 30 days, 90 days, 180 days, 12 months | The occurrence of Severe RHF composite after LVAD implantation |
| Haemolysis | 1 week, 30 days, 90 days, 180 days, 12 months | The occurrence of LVAD and driveline-related infection after LVAD implantation |
| Arterial thromboembolic events, including stroke | 1 week, 30 days, 90 days, 180 days, 12 months | The occurrence of LVAD and driveline-related infection after LVAD implantation |
| Venous thromboembolic events, including deep venous thrombosis (DVT) and pulmonary embolism (PE) | 1 week, 30 days, 90 days, 180 days, 12 months | The occurrence of LVAD and driveline-related infection after LVAD implantation |
| Ventricular arrhythmias, either sustained symptomatic or with appropriate Implantable Cardioverter Defibrillator (ICD) therapy | 1 week, 30 days, 90 days, 180 days, 12 months | The occurrence of LVAD and driveline-related infection after LVAD implantation |
| Atrial arrhythmias - documented atrial flutter or fibrillation | 1 week, 30 days, 90 days, 180 days, 12 months | The occurrence of LVAD and driveline-related infection after LVAD implantation |
| Acute Kidney Injury (AKI) according to Kidney Disease Outcomes Quality Initiative (KDIGO) and RIFFLE criteria | 1 week, 30 days, 90 days, 180 days, 12 months | The occurrence of LVAD and driveline-related infection after LVAD implantation |
| Chronic kidney disease (CKD) according to KDOQI criteria | 1 week, 30 days, 90 days, 180 days, 12 months | The occurrence of Chronic kidney disease (CKD) according to KDOQI criteria after LVAD implantation |
| Six Minute walk distance in meters | 90 days and 12 months | Assessment of Six Minute walk distance in meters before and after LVAD implantation |
| Quality of life (QoL) scores | 90 days, 180 days and at 12 months | QoL by multiple assessments before and at 90 days, 180 days and at 12 months after LVAD implantation at |
| LVAD pump thrombosis | 1 week, 30 days, 90 days, 180 days, 12 months | The occurrence of LVAD and driveline-related infection after LVAD implantation |
Countries
Germany, Hungary, Italy, Kazakhstan, Netherlands, Turkey (Türkiye), United Kingdom
Contacts
Primary ContactOsama SOLIMAN, MD, PhD
Backup ContactKadir Caliskan, MD, PhD
Outcome results
None listed