Puwanant Sarinya, Hamilton Karen K, Klodell Charles T, Hill James A, Schofield Richard S, Cleeton Timothy S, Pauly Daniel F, Aranda Juan M
Division of Cardiovascular Medicine, Department of Internal Medicine, University of Florida, Gainesville, Florida, USA.
J Heart Lung Transplant. 2008 Oct;27(10):1102-7. doi: 10.1016/j.healun.2008.07.022.
Right ventricular (RV) failure after left ventricular assist device (LVAD) implantation is associated with a high rate of morbidity and mortality. We sought to determine pre-operative right heart echocardiographic predictors of post-LVAD severe RV failure.
RV failure, defined as the need for inotropic support or pulmonary vasodilators for >or=14 days post-operatively, was evaluated in 33 patients (age 54 +/- 13 years) with LVADs. Preoperative RV systolic and diastolic echocardiographic parameters, including RV fractional area change, tricuspid annular motion, right atrial volume index, RV index of myocardial performance, hepatic vein Doppler velocities, tricuspid regurgitation severity, and RV systolic pressures (RVSPs) in patients with and without RV failure were compared.
Of the 33 patients evaluated, 11 (33%) had post-LVAD RV failure (2 needed RVAD support). Patients with post-LVAD RV failure had significantly lower pre-operative tricuspid annular motion (8 +/- 4 vs 15 +/- 6 mm, p < 0.01) and higher RVSPs (60 +/- 14 vs 46 +/- 11 mm Hg, p = 0.02). In 13 patients (39%) with moderate tricuspid regurgitation, pre-operative tricuspid annular motion remained significantly reduced (6.0 +/- 0.5 vs 13.5 +/- 5.0 mm, p = 0.045). Other echocardiographic parameters were not significantly different between patients. Tricuspid annular motion of <7.5 mm provides 91% specificity and 46% sensitivity in predicting post-LVAD RV failure.
Tricuspid annular motion is a predictor of post-LVAD RV failure. Using tricuspid annular motion in addition to conventional criteria may aid in early identification of patients with prolonged inotropic support or severe RV failure and allow for better pre-operative planning.
左心室辅助装置（LVAD）植入术后右心室（RV）衰竭与高发病率和死亡率相关。我们试图确定LVAD植入术后严重RV衰竭的术前右心超声心动图预测指标。
对33例（年龄54±13岁）接受LVAD治疗的患者评估RV衰竭情况，定义为术后需要使用血管活性药物支持或肺血管扩张剂≥14天。比较有和没有RV衰竭患者的术前RV收缩和舒张期超声心动图参数，包括RV面积变化分数、三尖瓣环运动、右心房容积指数、RV心肌性能指数、肝静脉多普勒流速、三尖瓣反流严重程度和RV收缩压（RVSP）。
在评估的33例患者中，11例（33%）出现LVAD植入术后RV衰竭（2例需要RVAD支持）。LVAD植入术后出现RV衰竭的患者术前三尖瓣环运动明显降低（8±4 vs 15±6 mm，p<0.01），RVSP更高（60±14 vs 46±11 mmHg，p = 0.02）。在13例（39%）有中度三尖瓣反流的患者中，术前三尖瓣环运动仍明显降低（6.0±0.5 vs 13.5±5.0 mm，p = 0.045）。患者之间的其他超声心动图参数无显著差异。三尖瓣环运动<7.5 mm预测LVAD植入术后RV衰竭的特异性为91%，敏感性为46%。
三尖瓣环运动是LVAD植入术后RV衰竭的预测指标。除传统标准外，使用三尖瓣环运动可能有助于早期识别需要长期血管活性药物支持或严重RV衰竭的患者，并有助于更好地进行术前规划。
