# Multimodality Assessment for Durable Mechanical Circulatory Support Implantation

## TL;DR

This paper discusses the importance of comprehensive assessments using multiple diagnostic tools to improve outcomes for patients receiving durable heart support devices.

## Contribution

The paper emphasizes a multidisciplinary framework integrating multimodal assessments for optimal selection of durable mechanical circulatory support candidates.

## Key findings

- Echocardiography and CMR data like LV ejection fraction and fwRVLS are critical for risk stratification.
- Right heart catheterization and CPET help identify hemodynamic and functional limitations.
- Systemic comorbidities must be evaluated to influence surgical risk and outcomes.

## Abstract

The prevalence of advanced heart failure (AdHF) is increasing globally, driven by population aging and improved survival rates in chronic heart failure (CHF). Durable Mechanical Circulatory Support (DMCS), particularly Left Ventricular Assist Devices (LVADs), has become a cornerstone in AdHF management. However, its successful implantation requires a comprehensive preoperative evaluation integrating cardiac, hemodynamic, and systemic assessments. Echocardiography and cardiac magnetic resonance (CMR) provide critical data for risk stratification—e.g., LV ejection fraction < 25%, LV end-diastolic diameter < 60 mm, or free wall RV longitudinal strain (fwRVLS) > −14% predict poorer outcomes. Right heart catheterization (RHC) identifies hemodynamic contraindications (PVR > 6 WU, PAPi < 1.5, cardiac index < 2 L/min/m2), while cardiopulmonary exercise testing (CPET) remains pivotal for assessing functional reserve (peak VO2 < 12 mL/kg/min or <50% predicted). Systemic assessment must address renal, hepatic, oncologic, and psychiatric comorbidities that influence surgical risk. Integrating these multimodal data within a multidisciplinary framework—spanning cardiologists, cardiac surgeons, anesthesiologists, and psychologists—optimizes selection and outcomes for DMCS candidates.