Non-invasive Liver Scores Can Predict Severe Acute Right Heart Failure after Left Ventricular Assist Device Implantation

Background: Severe right heart failure after LVAD implantation that requires postoperative temporary mechanical right ventricular support is a dreaded adverse event. Preoperative risk scores for right heart failure after LVAD implantation are, in general, complex and difficult to assess, making them inappropriate for daily routine. Calculation of non-invasive liver fibrosis scores may help to predict the risk of right heart failure.

Methods: Between August 2008 and July 2024, a total of n = 368 consecutive patients underwent LVAD implantation in our department. Of these, n = 22 (6.0%) required postoperative temporary mechanical right ventricular assistance (tRVAD). Different non-invasive liver fibrosis scores including Fibrosis-4 (FIB-4), Model of End Stage Liver Disease (MELD), Non-Alcoholic Fatty Liver Disease (NAFLD), HUI, and AST to Platelet Ratio Index (APRI) were calculated from preoperative laboratory values. The aim of the study was to correlate liver fibrosis scores with postoperative tRVAD after LVAD implantation.

Results: FIB-4 was available for n = 340 patients, MELD for n = 187, NALFD for n = 186, BARD for n = 195, HUI for n = 148, and APRI for n = 340 patients. Binary logistic regression revealed that NALFD was an independent risk factor for tRVAD with an odds ratio (OR) of 1.34 (CI = 1.06–1.71, p = 0.02) as well as FIB-4 (OR = 1.03, CI = 1.01–1.06, p = 0.02) and APRI (OR = 1.05, CI = 1.01–1.11, p = 0.03). The receiver operating characteristic (ROC) analysis showed that NALFD performed the best with an area under the curve (AUC) of 0.719 (CI = 0.58–0.86, p < 0.01) followed by FIB-4 (AUC = 0.636, CI = 0.51–0.77, p = 0.04). In contrast, APRI did not predict the risk of tRVAD in our cohort (AUC = 0.620, CI = 0.48–0.76, p = 0.09). The optimal cut-off value for NALFD was 2.22 (sensitivity 78%, specificity 65%) and 2.41 for FIB-4 (sensitivity 62%, specificity 60%). Combining NALFD and FIB-4, as well as different demographic characteristics, was unable to further increase the precision of the model.

Conclusion: We have shown that non-invasive liver fibrosis scores NALFD and FIB-4 can easily be calculated from regular laboratory values and are capable of predicting the risk of severe acute right heart failure after LVAD implantation with the need for tRVAD. Even if the specificity and sensitivity of the two scores are not ideal, the simplicity and cost-neutral calculation of the scores is a helpful addition in predicting a serious complication after LVAD implantation.

Publication History

Article published online:
11 February 2025