Tracking the RV
Our understanding of RHF before and after LVAD is clouded by the difficulties of imaging the RV, wherein the irregular bananoid shape and prominent trabeculations defy quantification. More routine access to 3-dimensional imaging may facilitate RV assessment during rest and stress. If we can better monitor the RV afterload and functional reserve, we may ultimately be able to prolong stability for patients with current INTERMACS Profile 5 or 6 compensated LV failure. Much discussion continues regarding the role for LVAD in "less sick" patients who can maintain good quality of life on medical therapy when followed carefully in specialized centers.[17] Even when patients appear stable, persistent elevation of pulmonary pressures may warrant more aggressive intervention. We need to change the trajectory of disease before the RV reaches the tipping point that jeopardizes the outcomes with both medical therapy and LVADs.
Funding Support and Author Disclosures
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
J Am Coll Cardiol. 2022;78(23) © 2022 American College of Cardiology Foundation
