Drakos et al developed a score to identify a patient who may be at risk for right ventricular failure following implantation of a left ventricular assist device (LVAD). This can help to identify a patient who may benefit from more aggressive management. The authors are from Intermountain Medical Center, University of Utah, University of Athens, Stanford University and Ochsner Clinic.
Patient selection: insertion of a left ventricular assist device (LVAD)
Outcome: right ventricular failure (RVF), defined as need for inhaled nitroc oxide for >= 48 hours OR intravenous inotropes for > 14 days OR implantation of a right ventricular assist device (RVAD)
Parameters:
(1) intent of LVAD
(2) intra-aortic balloon counterpulsation
(3) pulmonary vascular resistance in Wood units
(4) inotrope dependency
(5) obesity (body mass index >= 30 kg per square meter)
(6) therapy with angiotensin converting enzyme (ACE) inhibitor and/or angiotensin II receptor blocker
(7) therapy with beta blocker
Parameter
Finding
Points
intent of LVAD
temporary
0
destination therapy
3.5
IAB counterpulsation
no
0
yes
4
pulmonary vascular resistance
<= 1.7 Wood units
1
1.8 to 2.7 Wood units
2
2.8 to 4.2 Wood units
3
>= 4.3 Wood units
4
inotrope dependency
no
0
yes
2.5
obesity
no
0
yes
2
ACE and/or ARB therapy
no
0
yes
-2.5
beta blocker therapy
no
0
yes
2
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: -1.5
• maximum score: 18
Total Score
Risk Group
Risk RVF
<= 5
low
11%
5.5 to 8
medium
37%
8.5 to 12
high
56%
>= 12.5
very high
83%
Performance:
• The area under the ROC curve is 0.74.
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