Clinical InvestigationRight Ventricular Systolic and Diastolic Function as Assessed by Speckle-Tracking Echocardiography Improve With Prolonged Isolated Left Ventricular Assist Device Support
Section snippets
Study Population, Echocardiographic Studies, and Hemodynamic Data
Medical records, echocardiographic studies, and hemodynamics from right-heart catheterizations were retrospectively reviewed from a single center’s mechanical circulatory support program from January 2007 to July 2013. Patients were included for analysis if they underwent implantation of a Heartmate II LVAD for end-stage systolic heart failure and had an echocardiogram available for analysis at baseline before LVAD implantation and follow-up echocardiograms available ≥2 months after LVAD
Results
Clinical characteristics for the patients included in the cohort are provided in Table 1. The mean age at the time of LVAD implantation was 58.4 ± 15.2 years, and all 17 patients had New York Heart Association functional class IV symptoms. The majority were Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile level 2 or 3 at the time of LVAD implantation. The average duration of LVAD support in this cohort was 234 ± 125 days. The majority of patients were on
Discussion
The major finding of this study is that RV systolic and diastolic function improves over prolonged LVAD support. Serial measurements with the use of speckle-tracking echocardiography allowed for the quantitative assessment of both systolic and diastolic RV function. With >6 months of LVAD support, there were significant improvements in these measures of RV function, and these improvements occurred concomitantly with a significant reduction in pulmonary arterial pressure, pulmonary capillary
Conclusion
Among a cohort of Heartmate II LVAD patients who did not require a biventricular or RV assist device, both RV systolic and diastolic function as determined by speckle-tracking echocardiography improved with >6 months of LVAD support and was accompanied by reductions in measures of RV afterload. These findings suggest that for patients who are expected to require long-term LVAD support, even those patients with significant RV dysfunction at baseline would expect to have stabilization if not
Disclosures
Dr Ambardekar has received minor consulting fees from Cytokinetics.
Acknowledgment
The authors are grateful to Jennifer L. Dorosz, MD, for providing technical assistance with the speckle-tracking echocardiography software.
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Cited by (21)
Ventricular systolic dysfunction with and without altered myocardial contractility: Clinical value of echocardiography for diagnosis and therapeutic decision-making
2021, International Journal of CardiologyCitation Excerpt :A low pre-operative LAIRV was identified as a risk factor for RVF after LVAD implantation [126,140,146]. In a recent analysis of the clinical value of composite variables used for assessment of the RV in relation to its afterload for preoperative prediction of RV function after LVAD implantation, the LAIRV added the highest incremental prognostic value to validated risk scores [170]. After LVAD implantation, the RV GLS and GLSr appeared most useful for RV surveillance (more sensitive than RVEF, TAPSE, RVFW-LS and RVFW-LSr) [171].
Perioperative Assessment of Diastolic Function
2020, Diastology: Clinical Approach to Heart Failure with Preserved Ejection FractionRight ventricular strain in heart failure: Clinical perspective
2017, Archives of Cardiovascular DiseasesCitation Excerpt :A large meta-analysis that included 4428 patients with an LV assist device showed that RV free-wall longitudinal strain had the highest impact on prediction of RV failure in these patients [45]. Interestingly, a small investigation published recently demonstrated that prolonged LV assist device support significantly improved RV strain [49]. It is of great importance to be able to predict patients with vulnerable RV who could develop RV failure.
Right ventricular afterload sensitivity dramatically increases after left ventricular assist device implantation: A multi-center hemodynamic analysis
2016, Journal of Heart and Lung TransplantationCitation Excerpt :Given its retrospective nature and the aforementioned difficulties in rigorously assessing the RV echocardiographically post-LVAD, our study did not include echocardiographic measurements of RV load or adaptation. Our findings do corroborate those of Herod et al, who found that, at a relatively late post-LVAD assessment (mean 234 days, correlating roughly with the 7- to 12-month time period in our study), the majority of their 17-patient cohort demonstrated improvements in RV systolic strain and strain rate.35 Finally, our study could not provide further insight on the etiologic mechanisms of the observed hemodynamic changes.
Echocardiographic parameters associated with right ventricular failure after left ventricular assist device: A review
2016, Journal of Heart and Lung TransplantationCitation Excerpt :RV strain has also been used to serially monitor patients after LVAD placement to track changes in the RV post-operatively. In 3 case series, with a total of 95 patients, changes in strain in response to LVAD placement were associated with subsequent RV failure, suggesting that serial assessments of RV function using strain imaging could be used to track patients after device placement.25,27,29 Measures of right-heart enlargement are appealing indices to use in the prediction of post-LVAD RV failure.
Funding: Dr Ambardekar is supported by a Scientist Development Grant (13SDG17030001) from the American Heart Association and by the Boettcher Foundation's Webb-Waring Biomedical Research Program.
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