Post-implantation early right heart failure (RHF) following left ventricular assist device (LVAD) placement is characterized by a high incidence and poor prognosis. Current risk stratification models primarily rely on hemodynamic, imaging, and organ function parameters obtained under resting conditions, but their external validation and generalizability are limited. In contrast, stress testing, which increases cardiac load through vasodilators or exercise, offers incremental value in predicting postoperative RHF. This review centers on a dual-state assessment (rest and stress), summarizing the strengths and limitations of indices such as the ratio of central venous pressure to pulmonary artery wedge pressure (CVP/PAWP) and the pulmonary artery pulsatility index (PAPi). It further compares established risk models like CRITT score and European Registry for Patients with Mechanical Circulatory Support (EUROMACS), demonstrating the augmented predictive power of pharmacological or exercise stress testing. A stratified strategy is proposed, involving initial screening with static parameters followed by confirmatory stress testing. Furthermore, an integrated approach of incorporating stress-derived parameters into these models is suggested. Finally, the paper advocates for prospective validation studies in the cohort of patients receiving domestically-produced LVAD, with the aim of establishing a systematic framework to guide perioperative decision-making and enhance individualized prediction.
