Advanced Right Ventricular Functional Analysis for Right Ventricular Failure Risk in Pre-Implant Left Ventricular Assist Device Patients

项目摘要 机械循环支持(MCS)，特别是左心室辅助装置(LVAD)已经出现 在过去的几十年里，它是晚期心力衰竭患者的一种挽救生命的疗法。尽管如此，许多帖子 植入并发症，如右室衰竭(RVF)，仍然很常见。RVF提高了费率 死亡率、住院时间，可能需要植入右室辅助装置1。在……里面 为了识别这些患者，许多以前的研究人员基于以下因素创建了风险评分 定性评估、血流动力学和血液学参数。尽管如此，风险分数缺乏 临床广泛使用的敏感性和特异性，在交叉验证研究中失败。的Meta分析 这些研究已经确定了术前右室功能障碍的标记物是术后最有力的指标 手术失败。然而，这些标志物表明，术前RV通过不同的机制 功能障碍会导致RVF。术前收缩右室功能减退，室间功能减退 基础肺部疾病的恶化和不利的RV重构是主要形式 左冠状动脉成形术后发生右室颤动的功能障碍。每种机制对术后RVF的影响是 未知。在单个患者群体中对每种形式的原发性功能障碍的定量评估是 需要比较每种机制的作用。更好地理解RV的作用机制 功能障碍导致RVF将改善术前咨询和管理，并可能减少 随后的RVF。 拟议的项目旨在通过以下方式调查各种形式的术前功能障碍的影响 定量功能评估。尤其是右室搏动功，游离壁和隔壁劳损， 并将测量动脉-心室偶联来评估不同类型的RV损害。压力- 通过结合无创、单次心跳、CineCT衍生的体积测量，将重建体积环 用同期RV压力波形测量能量评估心脏收缩功能 右心室。此外，3D自由壁应变的测量将与间隔应变进行比较，以量化自由壁应变 左心衰竭的室壁代偿。最后，动脉-心室耦合将由单搏动产生。 压力-容量环衍生的心脏收缩末期弹性和CT衍生的测量 肺弹性。这将评估可能导致不良RV的组合心肺功能 改建。除了评估RV功能障碍的机制外，我们还将评估其预后能力 左前降支植入术后右室血流的这些指标。这项提议的长期目标是建立一个 全面的RV评估，可用于术前识别RVF高危患者。

Project Summary Mechanical circulatory supports (MCS), particularly left ventricular assist devices (LVADs), have emerged over the past few decades as a life saving therapy for patients with late stage heart failure. Despite this, many post implantation complications, such as right ventricular failure (RVF), remain common. RVF increases the rates of mortality, length of hospital stay, and can necessitate the implantation of a right ventricular assist device1. In an attempt to identify these patients, many previous researchers have created risk scores based on qualitative assessments, hemodynamic, and hematological parameters. In spite of this, risk scores lack the sensitivity and specificity for wide-spread clinical use, and fail in cross-validation studies. Meta analyses of these studies have identified markers of preoperative RV dysfunction as the strongest indicators of post operative failure. These markers, though, suggest different mechanisms by which preoperative RV dysfunction leads to RVF. Preoperatively reduced systolic RV function, reduced function from interventricular worsening, and adverse RV remodeling from underlying pulmonary disease are the primary forms of dysfunction from which RVF occurs post LVAD. The influence of each mechanism on postoperative RVF is unknown. Quantitative assessments of each form of primary dysfunction in a single patient population is needed to compare the role of each mechanism. Better understanding of the mechanism by which RV dysfunction leads to RVF would improve preoperative counseling and management, and could reduce subsequent RVF. The proposed project aims to investigate the influence of each form of preoperative dysfunction through quantitative functional assessments. In particular, right ventricular stroke work, free wall and septal wall strain, and arterial-ventricular coupling will be measured to evaluate different types of RV impairment. Pressure- volume loops will be recreated by combining noninvasive, single heartbeat, cineCT-derived volumetric measures with contemporaneous RV pressure waveforms to energetically assess the systolic function of the right ventricle. In addition, measures of 3D free wall strain will be compared to septal strain, to quantify free wall compensation in left heart failure. Lastly, arterial-ventricular coupling will be derived from single-beat estimates of pressure-volume loop derived ventricular end-systolic elastance and CT-derived measures of pulmonary elastance. This will assess combined cardiopulmonary function that may lead to adverse RV remodeling. In addition to evaluating the mechanisms of RV dysfunction, we will assess the prognostic ability of these metrics for RVF after LVAD implantation. The long-term goal of this proposal is to establish a comprehensive RV evaluation that can be used to preoperatively identify patients at a high risk for RVF.