Non-invasive assessment of myocardial recovery on chronic left ventricular assist device: Results associated with successful device removal
Non-invasive assessment of myocardial recovery on chronic left ventricular assist device: Results associated with successful device removal
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DOI：
10.1016/s1053-2498(03)00056-1
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发表时间：
2003-12-01
影响因子：
8.9
通讯作者：
Kormos, RL
中科院分区：
文献类型：
--
作者：
Gorcsan, J;Severyn, D;Kormos, RL
背景资料：在接受左心室辅助装置支持的心力衰竭患者中可能发生心肌恢复，但识别装置移除的候选人仍然具有挑战性。我们假设，在线定量超声心动图在试验中减少设备的支持单独或结合运动心肺功能测试可以评估心脏恢复，以预测成功的deviceremoval.Methods：我们研究了18例严重心力衰竭，年龄45 +/- 19岁，谁收到234 +/- 169天的辅助设备支持移植的桥梁。我们使用超声心动图中心室短轴图像的自动边界检测和无创动脉压来测量2至5分钟器械流量降低试验中的逐搏反应。我们还评估了14例患者谁可以exercise.Results的最大耗氧量：6例患者经历了心肌恢复，并成功地进行了设备取出; 12个仍然依赖设备。在短暂的低辅助装置血流情况下，移除装置的患者的超声心动图卒中面积增加了27% +/- 36% vs-24%+/- 12%（p < 0.05），装置依赖患者的面积变化分数增加了51% +/- 13% vs 23% +/- 11%（p < 0.05）。成功取出器械的患者的预负荷调整最大功率（相对负荷无关指数）估计值为6.7 +/- 2.1 mW/cm（4），而器械依赖患者为1.2 +/- 1.2 mW/cm（4）（p < 0.005）。心肌恢复患者的最大耗氧量为17.2 +/- 1.4 ml/kg/min，器械依赖患者的最大耗氧量为13.1 +/- 1.9 ml/kg/min（p < 0.005），与预负荷调整的最大功率相关（r = 0.89，p < 0.001）。最大耗氧量>16 ml/kg/min、每搏面积增加、面积变化分数增加>40%、或负荷前调整最大功率>4.0 mW/cm（4）且器械流速较低与器械成功取出相关（P < 0.05）。结论：在-线定量超声心动图单独或结合运动心肺试验可以评估接受左心室辅助的患者的心肌恢复，器械支持，并有可能识别出器械取出的临床候选患者。
Background: Myocardial recovery may occur in patients with heart failure who are receiving left ventricular assist-device support, but identification of candidates for device removal remains challenging. We hypothesized that on-line quantitative echocardiography during trials of decreased device support alone or in combination with exercise cardiopulmonary testing can assess cardiac recovery to predict successful device removal.Methods: We studied 18 patients with severe heart failure, aged 45 +/- 19 years, who received 234 +/- 169 days of assist-device support as a bridge to transplantation. We used echocardiographic automated border detection from mid-ventricular short-axis images and non-invasive arterial pressure to measure beat-to-beat responses in 2 to 5 minute trials of decreased device flow. We also assessed maximal oxygen consumption in 14 patients who could exercise.Results: Six patients experienced myocardial recovery and underwent successful device removal; 12 remained device dependent. With transient, low assist-device flow, patients with device removal had increased echocardiographic stroke area of 27% +/- 36% vs -24% +/- 12% (p < 0.05) and fractional area change of 51% +/- 13% vs 23% +/- 11% (p < 0.05) in the patients who were device dependent. Estimates of pre-load-adjusted maximal power, a relatively load-independent index, were 6.7 +/- 2.1 mW/cm(4) in patients with successful device removal vs 1.2 +/- 1.2 mW/cm(4) in patients who were device dependent (p < 0.005). Maximal oxygen consumption was 17.2 +/- 1.4 ml/kg/min in patients with myocardial recovery vs 13.1 +/- 1.9 ml/kg/min in patients who were device dependent (p < 0.005) and correlated with pre-load-adjusted maximal power (r = 0.89, p < 0.001). Maximal oxygen consumption >16 ml/kg/min, increased stroke area, >40% increase in fractional area change, or pre-load-adjusted maximal power >4.0 mW/cm(4) with low device flow were associated with successful device removal (P < 0.05).Conclusions: On-line quantitative echocardiography alone or combined with exercise cardiopulmonary testing can assess myocardial recovery of patients receiving left ventricular assist-device support and has the potential to identify patients who are clinical candidates for device removal.