4.3 Clinical usefulness of pressure dimension index and future perspectives
Predicting RVF is a major goal to reduce postoperative morbidity and/or mortality, but available evidence suggests that available parameters, indices or algorithms are insufficient to reach this goal (3). Since present data is obtained from a small sample of subjects enrolled from a single centre, it would not be reasonable to suggest that PDI could be incorporated in routine echocardiographic practice before LVAD implantation. Rather, PDI can be useful in selected cases to help clinicians identifying patients that would be at-risk for short term mortality who could benefit from intensive hemodynamic support in the postoperative period. However, we consider that the real value of the present “pilot” study is that a index combining both the functional and structural aspects of the RV could be more useful than traditional parameters that capture only one “dimension” of the RV. PDI or other similar “multidimensional” indices could be tested in future studies, which would allow a more precise classification of the right ventricular alterations in heart failure patients that are candidates for an LVAD.