Published on:2nd Feb, 2015
    Journal of Cardiovascular Disease Research, 2015; 6(1):1-11
    Original Article | doi:10.5530/jcdr.2015.1.1

    Pre-operative Speckle-tracking Imaging to Predict the Need for Right Ventricular Support in Patients Undergoing Left Ventricular Assist Device Implantation

    Authors:

    Lin Wang1*, Mark Jay Zucker2, Marc Cohen3, David Alan Baran2, Margarita Camacho2, Claudia Gidea2, Hui Zheng4, Michael Amponsah3, Chunguang Chen3

    1Cardiac Imaging, St. Francis Hospital, Roslyn, NY

    2Heart Failure Treatment and Transplant Program, Newark Beth Israel Medical Center, Newark, NJ

    3Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ

    4Biostatistics Center, Massachusetts General Hospital, Boston, MA.

    Abstract:

    Background: Right ventricular (RV) dysfunction after left ventricular assist device (LVAD) implantation significantly complicates post-device management and has been shown to be associated with increased mortality. Pre-operative identification of patients who may develop post-LVAD RV dysfunction is challenging. This study was designed to evaluate pre-operative echocardiographic speckle tracking imaging as a predictor of post operative RV dysfunction. Methods: Thirty-nine patients who underwent Heartmate II LVAD placement in a single center were studied. Pre- and post-operative clinical, hemodynamic, laboratory, and echocardiographic data were prospectively collected as part of an ongoing institutional LVAD database. RV strain parameters were measured retrospectively using off-line speckletracking analysis software. Results: Twenty five of 39 LVAD recipients developed acute RV failure during the early post-operative period. RV function in 14 of these recipients improved with inotropes and judicious adjustment of LVAD parameters. Eleven patients, however, expired despite aggressive medical therapy including 7 patients who underwent placement of an RVAD. These 11 individuals were identified as having significantly lower global RV strain prior to device placement (p<0.05). Seventy two percent of the patients with a peak longitudinal systolic RV strain higher than -3%, expired. Twenty-four of 27 (88%) patients with a global RV strain of -3% or lower survived without need for an RVAD (p<0.001). Hemodynamic, laboratory and traditional echocardiographic data were not predictive of post-LVAD RV dysfunction or survival. Multivariate analysis showed RV longitudinal strain, especially global strain, to be the only significant predictor of severe RV dysfunction. Conclusion: Poor intrinsic RV myocardial function is associated with a higher mortality in LVAD patients. Speckle-tracking echocardiography imaging, particularly, peak systolic global RV strain appears to be promising in predicting LVAD patients who require RVAD.

    Key words: Echocardiography, Heart Failure, Right heart function, Strain, Ventricular assist device.

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