Clinical Investigation
Right Ventricular Systolic and Diastolic Function as Assessed by Speckle-Tracking Echocardiography Improve With Prolonged Isolated Left Ventricular Assist Device Support

https://doi.org/10.1016/j.cardfail.2014.04.017Get rights and content

Abstract

Background

Right ventricular (RV) failure is a major cause of morbidity and mortality after left ventricular assist device (LVAD) implantation. Whether RV function deteriorates with prolonged LVAD support is unknown. Speckle-tracking echocardiography provides a sensitive, noninvasive, reproducible, and quantitative assessment of RV systolic and diastolic function.

Methods

Echocardiograms were retrospectively reviewed from before and after implantation of a Heartmate II LVAD. Speckle-tracking analysis was performed to measure RV longitudinal systolic strain, strain rate, and diastolic strain rate for each patient at baseline and over discrete time periods after LVAD implantation.

Results

Seventeen patients were included in the analysis, with an average follow-up after LVAD implantation of 234 ± 125 days. RV systolic strain improved in 15 patients, decreasing from −7.4 ± 2.3% to −9.7 ± 3.3% after LVAD (P = .026). Systolic strain rate improved in 11 patients, decreasing from −0.67 ± 0.25%/s to −0.96 ± 0.36%/s (P = .011). RV diastolic strain rate improved in 12 patients, increasing from 0.70 ± 0.33%/s to 1.02 ± 0.40%/s (P = .016).

Conclusions

Chronic LVAD support improves RV systolic and diastolic function in LVAD patients who did not require an RV assist device. Speckle-tracking echocardiography may offer a noninvasive technique for identifying and monitoring improvements in RV function in LVAD patients.

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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    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.

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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.

See page 505 for disclosure information.

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