UC San Diego

For patients in advanced stages of heart failure, a left ventricular assist device (LVAD) may be implanted to aid in systemic circulation, either as a bridge to heart transplant or as a destination therapy. As such, LVAD implantations have become a standard for patient care for end-stage heart failure patients who are unable to receive a heart transplant. A major complication, however, is the postoperative adverse event of right ventricular failure (RVF). RVF occurs in approximately 10-40% of all patients undergoing LVAD implantation and has been linked to longer length of stay in intensive care unit, lower quality of life, and higher mortality. As such, there is a critical need to identify patients who are at a high risk for RVF prior to implantation in order to optimize their patient care. Previous studies have attempted to assess risk using risk scores based on hemodynamics, patient characteristics, and disease presentation, but have found limited predictive potential. A major limitation of these previous studies is the difficulty to characterize pre-operative right ventricular function quantitatively. CT is uniquely able to aide in quantitative RV analysis as it provides clinicians with 3D volumetric data throughout the cardiac cycle and visualizations of localized function. Despite this, CT has seen very limited use to analyze preoperative RV function in this patient population. High quality volumetric data allows for advanced RV measures that have never been analyzed in a clinical setting. The focus of this work is to use pre-LVAD CT imaging to create tools that would improve preoperative RV assessment. To do this, we investigate (1) the ability of CT-derived volumetry assessment of global function to identify RV dysfunction. We then examined (2) the ability of combined volumetric and hemodynamic data to measure RV energetics. Finally, we use CT to investigate (3) the ability of regional RV function in the context of volumetric and hemodynamic data to identify RV dysfunction and identify possible pathophysiology of biventricular failure.