The Comparative Method

developed RVF at day 14 with a predictive accuracy of 76.5%. When we included postoperative RV-E/E ’ and RV-strain, the predictive accuracy increased to 80.9%, with a sensitivity of 66.7 % and a specificity of 88.7%. Conclusions Serial echocardiograms using TDI and STE before and soon after LVAD surgery may aid in identifying need to initiate targeted RVF specific therapy in this population. (J Am Coll Cardiol HF 2013;1:216–22) ª 2013 by the American College of Cardiology Foundation Despite significant advances in device technology and peri-operative care, right ventricular failure (RVF) remains a major cause of morbidity and mortality following left ventricular assist device (LVAD) surgery (1–3). Under LVAD support, right ventricular (RV) preload increases as a result of increased circulatory volume, whereas RV afterload is expected to decrease secondary to improvement in pulmonary vascular resistance (4). Septal wall shift induced by LVAD alters RV structure, which may worsen RV contractile and relaxation abnormalities (5). Therefore, consideration of RV systolic and diastolic reserve before and also after surgery is important to identify which patients may need RV-specific mechanical and medical support post-LVAD. Previously described RVF risk assessment strategies contain several limitations with regard to their general applicability. Most of these studies either included a combi-nation of pulsatile and nonpulsatile devices, or did not exclud