Background: While many risk models have been developed to predict prognosis in heart failure (HF), these models are rarely useful for the clinical practitioner as they include multiple variables that might be time-consuming to obtain, they are usually difficult to calculate and they may suffer from statistical overfitting. Present study aimed to investigate whether a simpler model, namely ACEF-MDRD score, could be used for predicting one-year mortality in HF patients. Methods: 748 cases within the SELFIE-HF registry had complete data to calculate ACEF-MDRD score. Patients were grouped into tertiles for analyses. Results: Significantly more patients within the ACEF-MDRDhigh tertile (30.0%) died within one year, as compared to other tertiles (10.8% and 16.1%, respectively, for ACEF-MDRDlow and ACEF-MDRDmed, p<0.001 for both comparisons). There was a stepwise decrease in one-year survival as ACEF-MDRD score increased (log-rank p<0.001). ACEF-MDRD was an independent predictor of survival after adjusting for other variables (OR: 1.14, 95%CI:1.04 – 1.24, p=0.006). ACEF-MDRD score offered similar accuracy to GWTG-HF score for prediction of one-year mortality (p=0.14). Conclusions: ACEF-MDRD is a predictor of mortality in patients with HF, and its usefulness is comparable to similar yet more complicated models.

Mustafa Çalışkan, MDa; Ömer Faruk Baycan, MDa; Fatma Betül Çelik, MDa; Tolga Sinan Güvenç, MDb; Adem Atıcı, MDa; Yasemin Çağ, MDa; Oğuz Konal, MDa; Tuğçe İrgi, MDa; Ümmühan Zeynep Bilgili, MDa; Mehmet Ali Ağırbaşlı, MDaa Medeniyet University Faculty of Medicine, Department of Internal Medical Sciences, Division of Cardiology, Istanbul, Turkeyb Istinye University School of Medicine, Department of Internal Medical Sciences, Division of Cardiology, Istanbul, TurkeyCorresponding Author: Tolga Sinan GüvençAddress for correspondence: Maltepe, İstinye Üniversitesi Topkapı Kampüsü, Teyyareci Sami Str. No.3, 34010 Zeytinburnu/İstanbulTel: 0850 283 6000Declarations of interest: none

Background: Right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation is a major cause of postoperative morbidity and mortality. Despite the availability of multiple imaging parameters, none of these parameters had adequate predictive accuracy for post-LVAD RVF. Aim: To study whether right ventricular pressure-dimension index (PDI), which is a novel echocardiographic index that combines both morphologic and functional aspects of the right ventricle, is predictive of post-LVAD RVF and survival. Methods: 49 cases that underwent elective LVAD implantation were retrospectively analyzed using data from an institutional registry. PDI was calculated by dividing systolic pulmonary artery pressure to the square of the right ventricular minor diameter. Cases were categorized according to tertiles. Results: Patients within the highest PDI tertile (PDI>3.62 mmHg/cm2) had significantly higher short-term mortality (42.8%) and combined short-term mortality and definitive RVF (50%) compared to other tertiles (p<0.05 for both, log-rank p for survival to 15th day 0.014), but mortality was similar across tertiles in the long-term follow up. PDI was an independent predictor of short-term mortality (HR:1.05–26.49, p=0.031) and short-term composite of mortality and definitive RVF (HR:1.37–38.87, p=0.027). Conclusions: Increased PDI is a marker of an overburdened right ventricle. Heart failure patients with a high PDI is at risk for short-term mortality following LVAD implantation.