Chapman Carrie B, Allana Salman, Sweitzer Nancy K, Kohmoto Takushi, Murray Margaret, Murray David, Johnson Maryl, Rahko Peter S
Cardiovascular Medicine Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792, USA.
Echocardiography. 2013 May;30(5):513-20. doi: 10.1111/echo.12100. Epub 2013 Jan 11.
The HeartMate II is the most frequently used left ventricular assist device (LVAD) in patients with end-stage heart failure. There is a paucity of data regarding its longitudinal cardiac effects, particularly that on diastole.
This retrospective study was an evaluation of echocardiograms preoperatively and at 3, 6, and 12 months postoperatively in patients with a HeartMate II. Measurements included left ventricle (LV) dimensions, ejection fraction (EF), right ventricle (RV) size and function, parameters of diastolic function, and an analysis of mitral regurgitation (MR), tricuspid regurgitation (TR), aortic insufficiency (AI), and aortic valve thickening.
Forty-seven patients were evaluated. LV dimensions decreased but EF, RV size, and RV function were unchanged. Right ventricular systolic pressure (RVSP) and diastolic parameters including mitral inflow E/A, deceleration time (DT), pulmonary vein inflow, left atrial size, and overall diastolic grade improved. LV relaxation measured by tissue Doppler (e') was unchanged and the E/e' ratio was also unchanged. Regarding valve function, MR decreased, TR was unchanged, and the aortic valve became increasingly thickened with increased AI severity.
The HeartMate II unloads the LV as shown by decreased LV size, decreased MR, reduced RVSP, and improved patterns of mitral inflow. However, neither systolic function nor diastolic relaxation improves in this cohort. RV size and function also remain unchanged. The aortic valve shows increased thickening and AI likely from valve leaflet fusion. These results provide detailed functional and hemodynamic information regarding the longitudinal effects of the HeartMate II.
HeartMate II是终末期心力衰竭患者中最常用的左心室辅助装置（LVAD）。关于其对心脏的长期影响，尤其是对舒张期的影响，数据较少。
这项回顾性研究评估了使用HeartMate II的患者术前以及术后3个月、6个月和12个月的超声心动图。测量指标包括左心室（LV）尺寸、射血分数（EF）、右心室（RV）大小和功能、舒张功能参数，以及对二尖瓣反流（MR）、三尖瓣反流（TR）、主动脉瓣关闭不全（AI）和主动脉瓣增厚情况的分析。
共评估了47例患者。左心室尺寸减小，但射血分数、右心室大小和右心室功能未改变。右心室收缩压（RVSP）以及包括二尖瓣流入E/A、减速时间（DT）、肺静脉流入、左心房大小和整体舒张分级在内的舒张参数有所改善。通过组织多普勒测量的左心室舒张功能（e'）未改变，E/e'比值也未改变。关于瓣膜功能，二尖瓣反流减少，三尖瓣反流未改变，主动脉瓣增厚且主动脉瓣关闭不全严重程度增加。
如左心室尺寸减小、二尖瓣反流减少、右心室收缩压降低以及二尖瓣流入模式改善所示，HeartMate II减轻了左心室负荷。然而，该队列中的收缩功能和舒张功能均未改善。右心室大小和功能也保持不变。主动脉瓣增厚且主动脉瓣关闭不全可能是由于瓣叶融合所致。这些结果提供了关于HeartMate II长期影响的详细功能和血流动力学信息。
