# Advanced Right Ventricular Functional Analysis for Right Ventricular Failure Risk in Pre-Implant Left Ventricular Assist Device Patients

> **NIH NIH F31** · UNIVERSITY OF CALIFORNIA, SAN DIEGO · 2022 · $25,654

## Abstract

Project Summary
Mechanical circulatory supports (MCS), particularly left ventricular assist devices (LVADs), have emerged over
the past few decades as a life saving therapy for patients with late stage heart failure. Despite this, many post
implantation complications, such as right ventricular failure (RVF), remain common. RVF increases the rates
of mortality, length of hospital stay, and can necessitate the implantation of a right ventricular assist device1. In
an attempt to identify these patients, many previous researchers have created risk scores based on
qualitative assessments, hemodynamic, and hematological parameters. In spite of this, risk scores lack the
sensitivity and specificity for wide-spread clinical use, and fail in cross-validation studies. Meta analyses of
these studies have identified markers of preoperative RV dysfunction as the strongest indicators of post
operative failure. These markers, though, suggest different mechanisms by which preoperative RV
dysfunction leads to RVF. Preoperatively reduced systolic RV function, reduced function from interventricular
worsening, and adverse RV remodeling from underlying pulmonary disease are the primary forms of
dysfunction from which RVF occurs post LVAD. The influence of each mechanism on postoperative RVF is
unknown. Quantitative assessments of each form of primary dysfunction in a single patient population is
needed to compare the role of each mechanism. Better understanding of the mechanism by which RV
dysfunction leads to RVF would improve preoperative counseling and management, and could reduce
subsequent RVF.
The proposed project aims to investigate the influence of each form of preoperative dysfunction through
quantitative functional assessments. In particular, right ventricular stroke work, free wall and septal wall strain,
and arterial-ventricular coupling will be measured to evaluate different types of RV impairment. Pressure-
volume loops will be recreated by combining noninvasive, single heartbeat, cineCT-derived volumetric
measures with contemporaneous RV pressure waveforms to energetically assess the systolic function of the
right ventricle. In addition, measures of 3D free wall strain will be compared to septal strain, to quantify free
wall compensation in left heart failure. Lastly, arterial-ventricular coupling will be derived from single-beat
estimates of pressure-volume loop derived ventricular end-systolic elastance and CT-derived measures of
pulmonary elastance. This will assess combined cardiopulmonary function that may lead to adverse RV
remodeling. In addition to evaluating the mechanisms of RV dysfunction, we will assess the prognostic ability
of these metrics for RVF after LVAD implantation. The long-term goal of this proposal is to establish a
comprehensive RV evaluation that can be used to preoperatively identify patients at a high risk for RVF.

## Key facts

- **NIH application ID:** 10390039
- **Project number:** 1F31HL158218-01A1
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN DIEGO
- **Principal Investigator:** Anderson Scott
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $25,654
- **Award type:** 1
- **Project period:** 2022-09-01 → 2023-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10390039

## Citation

> US National Institutes of Health, RePORTER application 10390039, Advanced Right Ventricular Functional Analysis for Right Ventricular Failure Risk in Pre-Implant Left Ventricular Assist Device Patients (1F31HL158218-01A1). Retrieved via AI Analytics 2026-09-03 from https://api.ai-analytics.org/grant/nih/10390039. Licensed CC0.

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