Right Ventricular Global Longitudinal Strain as a Predictor of Acute and Early Right Heart Failure Post Left Ventricular Assist Device Implantation.
Right Ventricular Global Longitudinal Strain as a Predictor of Acute and Early Right Heart Failure Post Left Ventricular Assist Device Implantation.
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DOI：
10.1097/mat.0000000000001467
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发表时间：
2022-03-01
期刊：
影响因子：
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通讯作者：
Han Y
中科院分区：
文献类型：
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作者：
Liang LW;Jamil A;Mazurek JA;Urgo KA;Wald J;Birati EY;Han Y
高达40%的左心室辅助装置（LVAD）植入后患者发生早期右心衰（RHF），并与发病率和死亡率增加相关。来自机械循环支持学术研究联盟（MCS-ARC）工作组的最新报告将早期RHF细分为早期急性RHF和早期植入后RHF。我们试图根据新的MCS-ARC定义确定右心室（RV）纵向应变（LS）预测RHF的有效性。我们回顾性分析2015-2018年间LVAD植入患者的临床和超声心动图资料。在lvad前超声心动图上测量4室（4ch）、左室流出道（RVOT）和肋下（SC）的RVLS。55例患者纳入本研究。6例患者（11%）出现早期急性RHF，需要术中同时植入RVAD。22例（40%）患者出现种植后RHF。早期急性RHF和植入后RHF患者的RVLS显著降低。在- 9.7%的截止值下，4ch RVLS预测RHF的敏感性为88.9%，特异性为77.8%，受试者工作特征曲线下面积为0.86 （95% CI 0.76-0.97）。超声心动图右心室应变在预测RHF方面优于更具侵入性的血流动力学测量和临床参数。
Early right heart failure (RHF) occurs in up to 40% of patients following left ventricular assist device (LVAD) implantation and is associated with increased morbidity and mortality. The most recent report from the Mechanical Circulatory Support-Academic Research Consortium (MCS-ARC) working group subdivides early RHF into early acute RHF and early post-implant RHF. We sought to determine the effectiveness of right ventricular (RV) longitudinal strain (LS) in predicting RHF according to the new MCS-ARC definition. We retrospectively analyzed clinical and echocardiographic data of patients who underwent LVAD implantation between 2015–2018. RVLS in the 4-chamber (4ch), RV outflow tract (RVOT), and subcostal (SC) views were measured on pre-LVAD echocardiograms. 55 patients were included in this study. Six patients (11%) suffered early acute RHF, requiring concomitant RVAD implantation intraoperatively. 22 patients (40%) had post-implant RHF. RVLS was significantly reduced in patients who developed early acute and post-implant RHF. At a cutoff of −9.7%, 4ch RVLS had a sensitivity of 88.9% and a specificity of 77.8% for predicting RHF and area under the receiver operating characteristic curve of 0.86 (95% CI 0.76–0.97). Echocardiographic RV strain outperformed more invasive hemodynamic measures and clinical parameters in predicting RHF.