EUROMACS = European Registry for patients with Mechanical Circulatory Support
Patient selection: continuous flow left ventricular assist device (LVAD)
Outcome: early severe right-sided heart failure
Parameters:
(1) right atrial (RA) to pulmonary capillary wedge pressure (PCWP) ratio
(2) hemoglobin in g/dL
(3) multiple intravenous inotropes
(4) INTERMACS class (out of 7 classes)
(5) severe right ventricular dysfunction
(6) cardiopulmonary bypass time in minutes
|
Parameter
|
Finding
|
Preoperative Score
|
Postoperative Score
|
|
RA to PCWP ratio
|
<= 0.54
|
0
|
0
|
|
|
> 0.54
|
2
|
1
|
|
hemoglobin
|
> 10 g/dL
|
0
|
0
|
|
|
<= 10 g/dL
|
1
|
1.5
|
|
multiple IV inotropes
|
no
|
0
|
0
|
|
|
yes
|
2.5
|
2
|
|
INTERMACS
|
1, 2 or 3
|
2
|
2
|
|
|
other
|
0
|
0
|
|
severe RV dysfunction
|
no
|
0
|
0
|
|
|
yes
|
2
|
1
|
|
bypass time
|
<= 100 minutes
|
NA
|
0
|
|
|
> 100 minutes
|
NA
|
1
|
where:
• Intermacs 1 is critical cardiogenic shock.
• Intermacs 2 is progressive decline.
• Intermacs 3 is inotropic dependent.
preoperative score =
= SUM(points for the 5 preoperative parameters)
postoperative score =
= SUM(points for the 6 postoperative parameters)
Interpretation:
• minimum preoperative and postoperative scores: 0
• maximum preoperative score: 9.5
• maximum postoperative score: 8.5
• The higher the score the greater the risk for early severe right-sided heart failure.
|
Preoperative Score
|
Right-sided Heart Failure
|
|
0 or 2
|
11-13%
|
|
2.5 to 4
|
26-28%
|
|
4.5 to 9.5
|
42-43%
|
|
Postoperative Score
|
Right-sided Heart Failure
|
|
0 or 2
|
10-12%
|
|
2.5 to 4
|
21-23%
|
|
4.5 to 8.5
|
39-40%
|
Performance:
• The area under the ROC curve was around 0.70.
