HFSA ePoster Library

The relationship between Right Ventricular (RV) function and gastrointestinal bleeding (GIB) after continuous flow left ventricular assist device (CF-LVAD) implantation has been an area of focus and frequent study. Herein we sought to determine whether preoperative RV function, as assessed noninvasively using two-dimensional (2D) strain analysis is a predictor for GIB. Methods: A total of 156 patients who underwent an implantation of a CF-LVAD at University of California, San Diego were prospectively recruited and studied over an 8-year period. Invasive and noninvasive hemodynamic measures were obtained and associations with GIB were investigated. Peak longitudinal strain of the RV free wall prior to CF-LVAD implantation was assessed with 2D speckle tracking. Results: A total of 97 episodes of GIB occurred in 47 (30.1%) patients after a median follow-up of 312 days (IQR 151.0-589.5). Patients with GIB had greater basal RV diastolic dimensions (5.3±1.0 cm vs. 4.9±0.9 cm, p=0.02) and worse longitudinal strain of the RV free wall (-9.9±4.0% vs. -11.6±4.1%, p=0.01). On multivariate analysis, RV free wall longitudinal strain, basal RV diastolic dimension, severity of mitral regurgitation, left atrial volume index, history of smoking, diabetes mellitus, stroke and prior GIB were independently associated with GIB. Conclusion: Pre-operative RV free wall longitudinal strain is associated with increased risk of GIB in patients after LVAD implantation, and hence may be used independent predictor of this common and morbid complication.