Maeder Micha T, Leet Angeline, Ross Andrew, Esmore Donald, Kaye David M
Heart Failure Research Group, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
J Heart Lung Transplant. 2009 Apr;28(4):360-6. doi: 10.1016/j.healun.2009.01.007.
Studies in explanted hearts from patients supported with a left ventricular assist device (LVAD) suggest that no or a less pronounced reverse remodeling process occurs in the right ventricle (RV) during LVAD support. The intermediate-term functional changes in RV function in patients with refractory heart failure (HF) supported with a continuous LVAD are not well characterized.
Serial transthoracic echocardiograms and simultaneous measurements of biochemical surrogates of disease severity and organ perfusion were obtained in 20 patients (aged 57 +/- 17 years) with refractory HF before and after implantation of a continuous-flow LVAD (VentrAssist, Ventracor Ltd, Chatswood, Australia).
After a median (interquartile range) follow-up of 140 days (34-367 days), RV diameter was reduced (36 +/- 7 vs 33 +/- 4 mm; p = 0.04), as was right atrial area (27 +/- 5 vs 24 +/- 6 cm(2); p = .04). There was a trend toward a reduction in tricuspid annulus plane systolic excursion (14 +/- 6 vs 13 +/- 5 mm; p = .05). RV fractional area change (26% +/- 13% vs 27% +/- 10%; p = .53) and global RV dysfunction graded visually using a scale from 0 (absent) to 3 (severe dysfunction) did not change from pre-implant to follow-up (2 [1-2] vs 1.5 [0.5-2]; p = .18). The degree of global RV dysfunction at follow-up was closely related to the degree of RV dysfunction at the pre-implant study (r = 0.69; p = .001). Changes in global RV dysfunction were inversely related to changes in glomerular filtration rate (r = -0.49; p = .03).
During continuous-flow LVAD support, pre-existing RV dysfunction does not worsen in the intermediate term.
对接受左心室辅助装置（LVAD）支持的患者的离体心脏研究表明，在LVAD支持期间，右心室（RV）未发生或仅发生不太明显的逆向重塑过程。对于接受持续性LVAD支持的难治性心力衰竭（HF）患者，RV功能的中期功能变化尚未得到充分描述。
对20例（年龄57±17岁）难治性HF患者在植入连续血流LVAD（VentrAssist，VentrAcor有限公司，澳大利亚查茨伍德）前后进行系列经胸超声心动图检查，并同时测量疾病严重程度和器官灌注的生化替代指标。
在中位（四分位间距）随访140天（34 - 367天）后，RV直径减小（36±7 vs 33±4 mm；p = 0.04），右心房面积也减小（27±5 vs 24±6 cm²；p = 0.04）。三尖瓣环平面收缩期位移有减小趋势（14±6 vs 13±5 mm；p = 0.05）。RV面积变化分数（26%±13% vs 27%±10%；p = 0.53）以及使用从0（无）到3（严重功能障碍）的量表进行视觉分级的整体RV功能障碍在植入前到随访期间未发生变化（2 [1 - 2] vs 1.5 [0.5 - 2]；p = 0.18）。随访时整体RV功能障碍程度与植入前研究时的RV功能障碍程度密切相关（r = 0.69；p = 0.001）。整体RV功能障碍的变化与肾小球滤过率的变化呈负相关（r = -0.49；p = 0.03）。
在连续血流LVAD支持期间，中期内已存在的RV功能障碍不会恶化。
