Dissociation Between Interstitial Fibrosis and Conventional Right Ventricular Assessment Markers in Advanced Heart Failure

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Preoperative assessment for left ventricular assist device implantation (LVAD) of right ventricular (RV) failure risk in heart failure (HF) patients remains challenging. Hemodynamic, echocardiographic, and biochemical parameters are dynamic and can change during optimization. We aimed to determine whether RV interstitial fibrosis, a less dynamic parameter, is independent of conventional RV functional parameters. Nineteen patients with Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles I-III undergoing LVAD implantation were enrolled. Preoperative echocardiographic and hemodynamic data were collected. Myocardial tissue samples from the left ventricular apex and RV free wall were obtained to quantify interstitial fibrosis. The mean patient age was 40 ± 14 years. Left ventricular and RV interstitial fibrosis showed moderate correlation (r = 0.48, p = 0.04). All patients were on inotropic support and 17 were on intra-aortic balloon pump support at the time of implantation. Right ventricular fibrosis did not correlate with hemodynamic, echocardiographic, or biochemical markers of RV function. In advanced heart failure patients, RV interstitial fibrosis is independent of conventional RV functional parameters. It may serve as a less dynamic, complementary marker for assessing intrinsic RV functional reserve and prognosis. Further investigation is warranted.

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