Performance of Risk Scores in Predicting Right Ventricular Failure After LVAD Implantation

Continuous-flow left ventricular assist devices (CF-LVADs) are central to advanced heart failure management but are complicated by right ventricular failure (RVF) in up to 40% of patients, increasing morbidity and mortality and underscoring the need for robust prediction tools. We performed a single-center retrospective study of CF-LVAD recipients from March 2009 to May 2024. Of 326 patients, 205 met inclusion criteria; RVF was defined as need for inotropes or right ventricular assist device support. We compared established RVF risk scores (Michigan, Penn/Fitzpatrick, European Registry for Patients with Mechanical Circulatory Support [EUROMACS], Central venous pressure, severe Right ventricular dysfunction, preoperative Intubation, severe Tricuspid regurgitation, Tachycardia [CRITT]) using receiver operating characteristic analysis, logistic regression, and internal validation. Among 205 patients, 81 (39.5%) developed post-LVAD RVF. The EUROMACS score had the highest predictive value (C-statistic 0.670, P < .001), followed by CRITT (0.653, P < .001), Penn (0.616, P = .004), and Michigan (0.606, P = .005). Youden-optimized cutoffs were derived to summarize sensitivity, specificity, positive predictive value, and negative predictive value. Mortality analysis was performed as a secondary exploratory endpoint. Overall, discrimination of existing RVF scores remained modest. EUROMACS performed best but highlighted the need to refine models with contemporary hemodynamic and echocardiographic metrics and to pursue rigorous external validation.