Speckle tracking echocardiography as a new technique to evaluate right ventricular function in patients with left ventricular assist device therapy

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• 作者：Matteo Cameli ; MD^a ; ^{cameli@cheapnet.it} ; Matteo Lisi ; MD^a ; Francesca Maria Righini ; MD^a ; Marta Focardi ; MD ; PhD^a ; Stefano Lunghetti ; MD^a ; Sonia Bernazzali ; MD^b ; Luca Marchetti ; MD^c ; Bonizella Biagioli ; MD^c ; Maurizio Galderisi ; MD^d ; Massimo Maccherini ; MD^b ; Guido Sani ; MD^b ; Sergio Mondillo ; MD^a
• 关键词：left ventricular assist device ; speckle tracking echocardiography ; right ventricular systolic function ; right ventricular myocardial deformation ; strain ; right ventricular failure
• 刊名：The Journal of Heart and Lung Transplantation
• 出版年：2013
• 出版时间：April, 2013
• 年：2013
• 卷：32
• 期：4
• 页码：424-430
• 全文大小：718 K

文摘

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Background

Right ventricular (RV) systolic function has a critical role in determining the clinical outcome and the success of using left ventricular assist devices (LVADs) in patients with refractory heart failure. RV deformation analysis by speckle tracking echocardiography (STE) has recently allowed a deeper analysis of RV longitudinal function. The aim of the study was to observe RV function by STE in patients with advanced heart failure before and after LVAD implantation.

Methods

Transthoracic echo Doppler was performed in 10 patients referred for LVAD therapy at baseline and with serial echocardiograms after LVAD implantation. In a sub-group of 4 patients, an echocardiographic evaluation was also made after intra-aortic balloon pump (IABP) support was initiated and before LVAD implantation. All echocardiographic images were analyzed off-line to calculate the free wall RV longitudinal strain (RVLS).

Results

Three patients who presented the lowest free wall RVLS values at baseline, showed a progressive decline of RVLS after LVAD implant, presenting finally RV failure; however, patients with higher values of RVLS at baseline presented a further and overt increase of strain values in the course of follow-up. The overall performance for the prediction of RV failure after LVAD implant was greatest for free wall RVLS (area under the curve, 0.93). For the sub-group receiving the IABP as an intermediate step, only 2 patients with an increase of RVLS after IABP implantation also showed an increase of RVLS levels, after subsequent LVAD implantation. The 2 patients without an increase of RVLS after IABP implantation also presented with RV failure after LVAD therapy.

Conclusions

This study of 10 patients indicates that the new parameter of RVLS, representing RV myocardial deformation, may have important clinical implications for the selection and management of LVAD patients. A large multicenter study is required to confirm these observations and to quantify the clinical significance of changes in RVLS value.