Despite technological advances in left ventricular assist device (LVAD) technology, which have made survival competitive with heart transplantation at 2 years, right ventricular failure (RVF), with an incidence of roughly 35%, continues to plague contemporary devices and is associated with significant long-term morbidity and mortality.^1–3 To avoid the development of RVF, patients at high risk are often evaluated preimplant for findings concerning for the potential development of postimplant RV failure. Numerous scoring systems have been investigated in the attempt to predict postimplant RV failure, but unfortunately, despite increasing sophistication of these scoring systems, overall discrimination of patients at risk for RV failure, particularly late RV failure, is modest.

One technology recently being leveraged to potentially assist in the management of hemodynamics after LVAD implantation is pulmonary artery (PA) pressure monitoring. In a recent prospective observational study, INTELLECT 2-HF, consistent trends in reduction in PA pressure postimplantation were observed with the CardioMEMS HF system (Abbott Laboratories, Abbott Park, IL) and facilitated improvement in medical management of left-sided volume overload.⁵ Unfortunately, absolute pressures pre-LVAD do not provide resolution about RVF since the relationship between PA pressures and RVF after LVAD is complex.⁶ However, a surrogate assessment of the pressure-equivalent hemodynamic energy can be obtained from PA pressure data, which may better reflect RV systolic function on LVAD support. We hypothesized that poor pulsatility would be associated with greater risk of RVF.