Research advances in echocardiographic and hemodynamic predictors of right ventricular failure after left ventricular assist device implantation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Lei , ZHOU Jian , YIN JiaLin , ZHANG Wenxiu , YANG Ting , CHEN Xin ,  XIAO Liqiong

Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, P. R. China;

Corresponding?author：

XIAO Liqiong, Email: Wl20121653@163.com

Keywords：

Heart failure; left ventricular assist device; right heart failure; hemodynamics; review

DOI：

10.7507/1007-4848.202510023

Video：

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Short-term left ventricular assist device (LVAD) has been widely applied in patients with end-stage heart failure, effectively improving hemodynamic perfusion and cardiac function. As a bridge to heart transplantation, this technology has rapidly developed. However, recent studies indicate that right heart failure (RHF) represents the most common complication following LVAD implantation, with an incidence rate of 25%-30%. This condition induces right-sided congestive symptoms, leading to deterioration of quality of life, reduced survival rates, and even compromising successful bridging to heart transplantation. Currently, diagnostic criteria and early identification methods for post-LVAD RHF remain under investigation, while echocardiographic parameters and invasive hemodynamic measurements provide comprehensive assessment of right ventricular function. Therefore, this study systematically reviews recent research findings from both domestic and international scholars regarding echocardiographic and hemodynamic predictors of RHF, aiming to identify potential directions for enhancing predictive capabilities of post-LVAD RHF.

1.	Cao I, Italiano EG, Bertelli F, et al. Intracorporeal LVAD implantation in pediatric patients: a single-center 10 years' experience. Artif Organs, 2024, 48(4): 408-417.
2.	Maharaj V, Agdamag AC, Duval S, et al. Hypotension on cardiopulmonary stress test predicts 90 day mortality after LVAD implantation in INTERMACS 3-6 patients. ESC Heart Fail, 2022, 9(5): 3496-3504.
3.	Newman E, Brailovsky Y, Rajapreyar I. Exercise and cardiac rehabilitation after LVAD implantation. Heart Fail Rev, 2025, 30(3): 469-476.
4.	Elder J, McComb J, Blitzer D, et al. ERAS including minimal narcotic pain management is successful after heart transplant and LVAD implantation: a single center review. JHLT Open, 2025, 9: 100267.
5.	Macera F, Dewachter C, Stefanidis C, et al. Lung diffusion capacity correlates with pre-implant pulmonary hypertension and predicts outcome after LVAD implantation. ESC Heart Fail, 2023, 10(2): 1043-1053.
6.	Cantarutti N, Adorisio R, Baban A, et al. Persistent myocardial atrophy despite LV reverse remodeling in Duchenne cardiomyopathy treated by LVAD. Pediatr Transplant, 2021, 25(2): e13890.
7.	Read JM, Azih NI, Peters CJ, et al. Hemodynamic reserve predicts early right heart failure after LVAD implantation. J Heart Lung Transplant, 2022, 41(12): 1716-1726.
8.	James L, Smith DE. Supporting the “forgotten” ventricle: the evolution of percutaneous RVADs. Front Cardiovasc Med, 2023, 9: 1008499.
9.	Miller T, Lang FM, Rahbari A, et al. Right heart failure after durable left ventricular assist device implantation. Expert Rev Med Devices, 2024, 21(3): 197-206.
10.	Liu H, Jones TE, Jeng E, et al. Risk stratification and optimization to prevent right heart failure during left ventricular assist device implantation. J Cardiothorac Vasc Anesth, 2021, 35(11): 3385-3393.
11.	Maukel LM, Schmeller S, Weidner G, et al. Psychosocial risk and recurrent hospitalizations in women and men following LVAD implantation: a multi-state analysis of the INTERMACS Registry. J Cardiovasc Dev Dis, 2025, 12(6): 198.
12.	Kormos RL, Antonides CFJ, Goldstein DJ, et al. Updated definitions of adverse events for trials and registries of mechanical circulatory support: a consensus statement of the mechanical circulatory support academic research consortium. J Heart Lung Transplant, 2020, 39(8): 735-750.
13.	Kunioka S, Seguchi O, Hada T, et al. Successful echocardiography-guided medical management of severe early post-implant right ventricular failure in a patient with left ventricular assist device support: a case report. J Cardiothorac Surg, 2023, 18(1): 269.
14.	Kim M, Uhm JS, Park JW, et al. The effects of radiofrequency catheter ablation for atrial fibrillation on right ventricular function. Korean Circ J, 2024, 54(4): 203-217.
15.	Stricagnoli M, Sciaccaluga C, Mandoli GE, et al. Clinical, echocardiographic and hemodynamic predictors of right heart failure after LVAD placement. Int J Cardiovasc Imaging, 2022, 38(3): 561-570.
16.	St?pór M, Pi?at A, Misiuda A, et al. Preoperative and mid-term right ventricular systolic function assessment, at rest and during exercise, with speckle-tracking echocardiography after left ventricular assist device implantation. Hellenic J Cardiol, 2024, 76: 31-39.
17.	Aloia E, Cameli M, D’Ascenzi F, et al. TAPSE: an old but useful tool in different diseases. Int J Cardiol, 2016, 225: 177-183.
18.	F?rber G, Schwan I, Kirov H, et al. Durability of tricuspid valve repair in patients undergoing left ventricular assist device implantation. J Clin Med, 2024, 13(5): 1411.
19.	Ingvarsson A, Gjesdal G, Borgenvik S, et al. Impact of bridging with left ventricular assist device on right ventricular function following heart transplantation. ESC Heart Fail, 2022, 9(3): 1864-1874.
20.	Benedetto M, Piccone G, Nardozi L, et al. Proportion of right ventricular failure and echocardiographic predictors in continuous-flow left ventricular assist device: a systematic review and meta-analysis. Indian J Thorac Cardiovasc Surg, 2023, 39(Suppl 1): 170-181.
21.	Bartoli CR, Hennessy-Strahs S, Dowling RD, et al. Abnormalities in the Von Willebrand-angiopoietin axis contribute to dysregulated angiogenesis and angiodysplasia in children with a Glenn circulation. JACC Basic Transl Sci, 2021, 6(3): 222-235.
22.	Yang BQ, Park AC, Liu J, et al. A distinct inflammatory milieu in patients with right heart failure. medRxiv, 2023.
23.	Miller T, Lang FM, Rahbari A, et al. Right heart failure after durable left ventricular assist device implantation. Expert Rev Med Devices, 2024, 21(3): 197-206.
24.	Eisen HJ. Left ventricular assist devices (LVADS): history, clinical application and complications. Korean Circ J, 2019, 49(7): 568-585.
25.	Finsberg H, Xi C, Zhao X, et al. Computational quantification of patient-specific changes in ventricular dynamics associated with pulmonary hypertension. Am J Physiol Heart Circ Physiol, 2019, 317(6): H1363-H1375.
26.	Kiernan MS, French AL, DeNofrio D, et al. Preoperative three-dimensional echocardiography to assess risk of right ventricular failure after left ventricular assist device surgery. J Card Fail, 2015, 21(3): 189-197.
27.	Raina A, Seetha Rammohan HR, Gertz ZM, et al. Postoperative right ventricular failure after left ventricular assist device placement is predicted by preoperative echocardiographic structural, hemodynamic, and functional parameters. J Card Fail, 2013, 19(1): 16-24.
28.	Mitra A, Siddique A. Tricuspid regurgitation in the setting of LVAD support. Front Cardiovasc Med, 2023, 10: 1090150.
29.	Hoopes C. Tricuspid surgery at the time of LVAD implant: a critique. Front Cardiovasc Med, 2022, 9: 1056414.
30.	Welp H, Sindermann J, Scherer M. Tricuspid valve reconstruction in patients with right heart decompensation due to severe tricuspid regurgitation on LVAD support. J Clin Med, 2024, 13(22): 6705.
31.	Mirza KK, Jung MH, Sigvardsen PE, et al. Computed tomography-estimated right ventricular function and exercise capacity in patients with continuous-flow left ventricular assist devices. ASAIO J, 2020, 66(1): 8-16.
32.	Baratto C, Caravita S, Dewachter C, et al. Right heart adaptation to exercise in pulmonary hypertension: an invasive hemodynamic study. J Card Fail, 2023, 29(9): 1261-1272.
33.	Bouchez S, Erb J, Foubert L, et al. Pressure-volume loops for reviewing right ventricular physiology and failure in the context of left ventricular assist device implantation. Semin Cardiothorac Vasc Anesth, 2023, 27(4): 283-291.
34.	Lazzari C. Ventricular and atrial pressure-volume loops: analysis of the effects induced by right centrifugal pump assistance. Bioengineering, 2022, 9(5): 181.
35.	Graefe R, Beyel C, Henseler A, et al. The effect of LVAD pressure sensitivity on the assisted circulation under consideration of a mitral insufficiency: an in vitro study. Artif Organs, 2018, 42(10): E304-E314.
36.	Morine KJ, Kiernan MS, Pham DT, et al. Pulmonary artery pulsatility index is associated with right ventricular failure after left ventricular assist device surgery. J Card Fail, 2026, 22(2): 110-116.
37.	Takenaka S, Sato T, Nagai T, et al. Impact of right ventricular reserve on exercise capacity and quality of life in patients with left ventricular assist device. Am J Physiol Heart Circ Physiol, 2023, 324(3): H355-H363.
38.	Imamura T, Kinugawa K, Kinoshita O, et al. High pulmonary vascular resistance in addition to low right ventricular stroke work index effectively predicts biventricular assist device requirement. J Artif Organs, 2016, 19(1): 44-53.
39.	Grandin EW, Zamani P, Mazurek JA, et al. Right ventricular response to pulsatile load is associated with early right heart failure and mortality after left ventricular assist device. J Heart Lung Transplant, 2017, 36(1): 97-105.
40.	Ruiz-Cano MJ, Morshuis M, Koster A, et al. Risk factors of early right ventricular failure in patients undergoing LVAD implantation with intermediate Intermacs profile for advanced heart failure. J Card Surg, 2020, 35(8): 1832-1839.
41.	Tsuji M, Kurihara T, Isotani Y, et al. Right heart reserve function assessed with fluid loading predicts late right heart failure after left ventricular assist device implantation. Can J Cardiol, 2024, 40(9): 1745-1754.
42.	Read JM, Azih NI, Peters CJ, et al. Hemodynamic reserve predicts early right heart failure after LVAD implantation. J Heart Lung Transplant, 2022, 41(12): 1716-1726.

1. Cao I, Italiano EG, Bertelli F, et al. Intracorporeal LVAD implantation in pediatric patients: a single-center 10 years' experience. Artif Organs, 2024, 48(4): 408-417.
2. Maharaj V, Agdamag AC, Duval S, et al. Hypotension on cardiopulmonary stress test predicts 90 day mortality after LVAD implantation in INTERMACS 3-6 patients. ESC Heart Fail, 2022, 9(5): 3496-3504.
3. Newman E, Brailovsky Y, Rajapreyar I. Exercise and cardiac rehabilitation after LVAD implantation. Heart Fail Rev, 2025, 30(3): 469-476.
4. Elder J, McComb J, Blitzer D, et al. ERAS including minimal narcotic pain management is successful after heart transplant and LVAD implantation: a single center review. JHLT Open, 2025, 9: 100267.
5. Macera F, Dewachter C, Stefanidis C, et al. Lung diffusion capacity correlates with pre-implant pulmonary hypertension and predicts outcome after LVAD implantation. ESC Heart Fail, 2023, 10(2): 1043-1053.
6. Cantarutti N, Adorisio R, Baban A, et al. Persistent myocardial atrophy despite LV reverse remodeling in Duchenne cardiomyopathy treated by LVAD. Pediatr Transplant, 2021, 25(2): e13890.
7. Read JM, Azih NI, Peters CJ, et al. Hemodynamic reserve predicts early right heart failure after LVAD implantation. J Heart Lung Transplant, 2022, 41(12): 1716-1726.
8. James L, Smith DE. Supporting the “forgotten” ventricle: the evolution of percutaneous RVADs. Front Cardiovasc Med, 2023, 9: 1008499.
9. Miller T, Lang FM, Rahbari A, et al. Right heart failure after durable left ventricular assist device implantation. Expert Rev Med Devices, 2024, 21(3): 197-206.
10. Liu H, Jones TE, Jeng E, et al. Risk stratification and optimization to prevent right heart failure during left ventricular assist device implantation. J Cardiothorac Vasc Anesth, 2021, 35(11): 3385-3393.
11. Maukel LM, Schmeller S, Weidner G, et al. Psychosocial risk and recurrent hospitalizations in women and men following LVAD implantation: a multi-state analysis of the INTERMACS Registry. J Cardiovasc Dev Dis, 2025, 12(6): 198.
12. Kormos RL, Antonides CFJ, Goldstein DJ, et al. Updated definitions of adverse events for trials and registries of mechanical circulatory support: a consensus statement of the mechanical circulatory support academic research consortium. J Heart Lung Transplant, 2020, 39(8): 735-750.
13. Kunioka S, Seguchi O, Hada T, et al. Successful echocardiography-guided medical management of severe early post-implant right ventricular failure in a patient with left ventricular assist device support: a case report. J Cardiothorac Surg, 2023, 18(1): 269.
14. Kim M, Uhm JS, Park JW, et al. The effects of radiofrequency catheter ablation for atrial fibrillation on right ventricular function. Korean Circ J, 2024, 54(4): 203-217.
15. Stricagnoli M, Sciaccaluga C, Mandoli GE, et al. Clinical, echocardiographic and hemodynamic predictors of right heart failure after LVAD placement. Int J Cardiovasc Imaging, 2022, 38(3): 561-570.
16. St?pór M, Pi?at A, Misiuda A, et al. Preoperative and mid-term right ventricular systolic function assessment, at rest and during exercise, with speckle-tracking echocardiography after left ventricular assist device implantation. Hellenic J Cardiol, 2024, 76: 31-39.
17. Aloia E, Cameli M, D’Ascenzi F, et al. TAPSE: an old but useful tool in different diseases. Int J Cardiol, 2016, 225: 177-183.
18. F?rber G, Schwan I, Kirov H, et al. Durability of tricuspid valve repair in patients undergoing left ventricular assist device implantation. J Clin Med, 2024, 13(5): 1411.
19. Ingvarsson A, Gjesdal G, Borgenvik S, et al. Impact of bridging with left ventricular assist device on right ventricular function following heart transplantation. ESC Heart Fail, 2022, 9(3): 1864-1874.
20. Benedetto M, Piccone G, Nardozi L, et al. Proportion of right ventricular failure and echocardiographic predictors in continuous-flow left ventricular assist device: a systematic review and meta-analysis. Indian J Thorac Cardiovasc Surg, 2023, 39(Suppl 1): 170-181.
21. Bartoli CR, Hennessy-Strahs S, Dowling RD, et al. Abnormalities in the Von Willebrand-angiopoietin axis contribute to dysregulated angiogenesis and angiodysplasia in children with a Glenn circulation. JACC Basic Transl Sci, 2021, 6(3): 222-235.
22. Yang BQ, Park AC, Liu J, et al. A distinct inflammatory milieu in patients with right heart failure. medRxiv, 2023.
23. Miller T, Lang FM, Rahbari A, et al. Right heart failure after durable left ventricular assist device implantation. Expert Rev Med Devices, 2024, 21(3): 197-206.
24. Eisen HJ. Left ventricular assist devices (LVADS): history, clinical application and complications. Korean Circ J, 2019, 49(7): 568-585.
25. Finsberg H, Xi C, Zhao X, et al. Computational quantification of patient-specific changes in ventricular dynamics associated with pulmonary hypertension. Am J Physiol Heart Circ Physiol, 2019, 317(6): H1363-H1375.
26. Kiernan MS, French AL, DeNofrio D, et al. Preoperative three-dimensional echocardiography to assess risk of right ventricular failure after left ventricular assist device surgery. J Card Fail, 2015, 21(3): 189-197.
27. Raina A, Seetha Rammohan HR, Gertz ZM, et al. Postoperative right ventricular failure after left ventricular assist device placement is predicted by preoperative echocardiographic structural, hemodynamic, and functional parameters. J Card Fail, 2013, 19(1): 16-24.
28. Mitra A, Siddique A. Tricuspid regurgitation in the setting of LVAD support. Front Cardiovasc Med, 2023, 10: 1090150.
29. Hoopes C. Tricuspid surgery at the time of LVAD implant: a critique. Front Cardiovasc Med, 2022, 9: 1056414.
30. Welp H, Sindermann J, Scherer M. Tricuspid valve reconstruction in patients with right heart decompensation due to severe tricuspid regurgitation on LVAD support. J Clin Med, 2024, 13(22): 6705.
31. Mirza KK, Jung MH, Sigvardsen PE, et al. Computed tomography-estimated right ventricular function and exercise capacity in patients with continuous-flow left ventricular assist devices. ASAIO J, 2020, 66(1): 8-16.
32. Baratto C, Caravita S, Dewachter C, et al. Right heart adaptation to exercise in pulmonary hypertension: an invasive hemodynamic study. J Card Fail, 2023, 29(9): 1261-1272.
33. Bouchez S, Erb J, Foubert L, et al. Pressure-volume loops for reviewing right ventricular physiology and failure in the context of left ventricular assist device implantation. Semin Cardiothorac Vasc Anesth, 2023, 27(4): 283-291.
34. Lazzari C. Ventricular and atrial pressure-volume loops: analysis of the effects induced by right centrifugal pump assistance. Bioengineering, 2022, 9(5): 181.
35. Graefe R, Beyel C, Henseler A, et al. The effect of LVAD pressure sensitivity on the assisted circulation under consideration of a mitral insufficiency: an in vitro study. Artif Organs, 2018, 42(10): E304-E314.
36. Morine KJ, Kiernan MS, Pham DT, et al. Pulmonary artery pulsatility index is associated with right ventricular failure after left ventricular assist device surgery. J Card Fail, 2026, 22(2): 110-116.
37. Takenaka S, Sato T, Nagai T, et al. Impact of right ventricular reserve on exercise capacity and quality of life in patients with left ventricular assist device. Am J Physiol Heart Circ Physiol, 2023, 324(3): H355-H363.
38. Imamura T, Kinugawa K, Kinoshita O, et al. High pulmonary vascular resistance in addition to low right ventricular stroke work index effectively predicts biventricular assist device requirement. J Artif Organs, 2016, 19(1): 44-53.
39. Grandin EW, Zamani P, Mazurek JA, et al. Right ventricular response to pulsatile load is associated with early right heart failure and mortality after left ventricular assist device. J Heart Lung Transplant, 2017, 36(1): 97-105.
40. Ruiz-Cano MJ, Morshuis M, Koster A, et al. Risk factors of early right ventricular failure in patients undergoing LVAD implantation with intermediate Intermacs profile for advanced heart failure. J Card Surg, 2020, 35(8): 1832-1839.
41. Tsuji M, Kurihara T, Isotani Y, et al. Right heart reserve function assessed with fluid loading predicts late right heart failure after left ventricular assist device implantation. Can J Cardiol, 2024, 40(9): 1745-1754.
42. Read JM, Azih NI, Peters CJ, et al. Hemodynamic reserve predicts early right heart failure after LVAD implantation. J Heart Lung Transplant, 2022, 41(12): 1716-1726.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesResearch advances in echocardiographic and hemodynamic predictors of right ventricular failure after left ventricular assist device implantation

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