Preoperative Left Ventricular Diastolic Dimension Index Is Associated With Outcomes After HeartMate 3 Implantation

Abstract

Abstract Objective We investigated the association between indexed left ventricular diastolic dimension and clinical outcomes after HeartMate 3 implantation. Methods We retrospectively reviewed patients implanted with the HeartMate 3 at our center between November 2014 and September 2021. Left ventricular diastolic dimension was assessed via preoperative transthoracic echocardiography and left ventricular diastolic dimension index was calculated as left ventricular diastolic dimension/body surface area. The primary outcome was a composite of death or readmission due to right heart failure or stroke. The cut-off left ventricular diastolic dimension index value most closely associated with outcomes was determined by receiver-operating characteristic curve and restricted cubic spline analyses. Results Left ventricular diastolic dimension index measurements were available for 252 of 253 (99.6%) patients. Using a left ventricular diastolic dimension index cut-off value of 33.5 mm/m2, the cohort was divided: left ventricular diastolic dimension index ≤ (n = 131) or > (n=121) 33.5 mm/m2. While there were no significant differences in age, INTERMACS level, and preoperative hemodynamics between groups, patients with smaller left ventricular diastolic dimension index were more likely to have a larger body surface area (2.1 vs 1.9 m2, P<0.001), ischemic cardiomyopathy (64 [49%] vs 40 [33%], P=0.01), and smaller left atrium volume index (40.5 [32.3-54.0] mL/m2 vs. 54.0 [43.0-66.8] mL/m2, P<0.001). Smaller left ventricular diastolic dimension index patients had significantly worse survival (74% vs 88%, log-rank P=0.009) and freedom from adverse events (55% vs 73%, log-rank P=0.005) at 3-year follow-up. Smaller left ventricular diastolic dimension index was independently associated with the composite outcome (Hazard ratio 2.24, P=0.002). Conclusions Smaller preoperative left ventricular diastolic dimension index is associated with worse outcomes in patients undergoing HeartMate 3 implantation.