Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
J Am Soc Echocardiogr. 2011 Feb;24(2):157-69. doi: 10.1016/j.echo.2010.12.022.
Continuous-flow left ventricular assist devices (LVADs) have become part of the standard of care for the treatment of advanced heart failure. However, knowledge of normal values for transthoracic echocardiographic examination and measurements in these patients are lacking.
All transthoracic echocardiographic examinations in 63 consecutive patients, performed 90 and 180 days after surgery with the implantation of a HeartMate II continuous-flow LVAD between February 2007 and January 2010, were retrospectively analyzed. All patients had to be outpatients at 3 and 6 months after surgery and considered stable on LVAD therapy (New York Heart Association class I or II and no need for inotropes, intravenous furosemide, or hospitalization).
End-diastolic and end-systolic diameters and left ventricular mass decreased considerably compared with baseline measurements before LVAD implantation. Mitral inflow deceleration time increased (188 ± 70 vs 132.5 ± 27 msec, P = .009) and left atrial volume (84.1 ± 33 vs 141.7 ± 62 mL, P = .003) and E/e' ratio decreased (20.3 ± 9 vs 26 ± 11, P = .01), all consistent with decreased left ventricular filling pressure. Estimated right ventricular (RV) and right atrial pressure decreased significantly (34.1 ± 10 vs 51.7 ± 14 mm Hg and 9.5 ± 5 vs 14.4 ± 5 mm Hg, respectively, P < .0001 for both). Quantitatively estimated RV function (P = .02), RV fractional area change (27.9 ± 10% vs 37.4 ± 10.9%, P < .0001), and the RV index of myocardial performance (0.32 ± 0.1 vs 0.65 ± 0.2 vs 0.32 ± .01, P < .0001) improved, suggesting improved RV efficiency. LVAD therapy resulted in significant decreases in the severity of mitral regurgitation. Tricuspid regurgitation improved in patients who had concurrent tricuspid surgical correction and was unchanged otherwise. Aortic regurgitation severity increased 3 months after LVAD implantation. There were no significant differences in any of the echocardiographic parameters in the 6-month evaluation compared with the 3-month evaluation.
This is the first report of selected typical echocardiographic values in a group of stable patients with normally functioning HeartMate II continuous-flow LVADs. A stable functioning continuous LVAD is associated with evidence of efficient unloading of the left ventricle, improved RV function, significant improvement in mitral regurgitation, improvement in tricuspid regurgitation only in patients undergoing repair, and increased aortic regurgitation. These normal data provide a basis for future echocardiographic studies after LVAD implantation.
连续血流左心室辅助装置（LVAD）已成为治疗晚期心力衰竭的标准治疗方法之一。然而，对于这些患者的经胸超声心动图检查和测量的正常值知之甚少。
对 2007 年 2 月至 2010 年 1 月期间植入 HeartMate II 连续血流 LVAD 的 63 例连续患者，在手术后 90 天和 180 天进行的所有经胸超声心动图检查进行回顾性分析。所有患者均需在手术后 3 个月和 6 个月接受门诊治疗，且认为 LVAD 治疗稳定（纽约心脏协会 I 或 II 级，无需使用正性肌力药物、静脉呋塞米或住院治疗）。
与 LVAD 植入前的基线测量值相比，舒张末期和收缩末期直径以及左心室质量显著减小。二尖瓣流入减速时间增加（188 ± 70 对 132.5 ± 27 毫秒，P =.009），左心房容积（84.1 ± 33 对 141.7 ± 62 毫升，P =.003）和 E/e' 比值降低（20.3 ± 9 对 26 ± 11，P =.01），均与左心室充盈压降低一致。估计的右心室（RV）和右心房压力显著降低（34.1 ± 10 对 51.7 ± 14 毫米汞柱和 9.5 ± 5 对 14.4 ± 5 毫米汞柱，均 P <.0001）。定量估计的 RV 功能（P =.02）、RV 节段面积变化（27.9 ± 10% 对 37.4 ± 10.9%，P <.0001）和 RV 心肌性能指数（0.32 ± 0.1 对 0.65 ± 0.2 对 0.32 ±.01，P <.0001）均有所改善，提示 RV 效率提高。LVAD 治疗可显著降低二尖瓣反流的严重程度。同时进行三尖瓣手术矫正的患者的三尖瓣反流得到改善，否则则保持不变。LVAD 植入后 3 个月主动脉瓣反流严重程度增加。与 3 个月评估相比，6 个月评估时的任何超声心动图参数均无显著差异。
这是一组稳定的 HeartMate II 连续血流 LVAD 患者中选择的典型超声心动图值的首次报告。稳定的连续 LVAD 功能与左心室有效卸载、RV 功能改善、二尖瓣反流显著改善、仅在接受修复的患者中改善三尖瓣反流以及增加主动脉瓣反流有关。这些正常数据为 LVAD 植入后的未来超声心动图研究提供了依据。
