Heart Failure and Cardiac Transplant Center, Tufts Medical Center, Boston, Massachusetts.
Heart Failure and Cardiac Transplant Center, Tufts Medical Center, Boston, Massachusetts.
J Card Fail. 2015 Mar;21(3):189-97. doi: 10.1016/j.cardfail.2014.12.009. Epub 2014 Dec 20.
Right ventricular failure (RVF) is associated with significant morbidity after left ventricular assist device (LVAD) surgery. Hemodynamic, clinical, and 2-dimensional echocardiographic variables poorly discriminate patients at risk of RVF. We examined the utility of 3-dimensional echocardiography (3DE) right ventricular (RV) volumetric assessment to identify patients at risk for RVF.
RVF was defined as the need for inotropic infusion for >14 days after LVAD surgery or the need for biventricular assist device support. Preoperative RV volumes and ejection fraction (EF) were measured, blinded to clinical data, from transthoracic 3DE full volume data sets in 26 patients. Baseline variables and 3DE RV indices were compared between patients with and without RVF. Twenty-four patients received continuous-flow LVADs, and 2 required biventricular support devices. Ten patients required prolonged inotropes after LVAD placement. Baseline characteristics associated with RVF included higher right atrial pressure, higher right atrial pressure to pulmonary capillary wedge pressure ratio, and lower cardiac index and RV stroke work index (RVSWI). Echocardiographic indices associated with RVF included 3DE indexed RV end-diastolic and end-systolic volumes (RVEDVI and RVESVI) and RV ejection fraction (RVEF). The relationship between 3DE quantification of RV volumes and the development of RVF was independent from RVSWI: RVEDVI: odds ratio (OR) 1.16, 95% confidence interval (CI) 1.00-1.33 (P = .04); RVESVI: OR 1.14, 95% CI 1.01-1.28 (P = .03).
Quantitative 3DE is a promising method for pre-LVAD RV assessment. RV volumes assessed by 3DE are predictive of RVF in LVAD recipients independently from hemodynamic correlates of RV function.
左心室辅助装置（LVAD）手术后，右心衰竭（RVF）与显著的发病率相关。血流动力学、临床和二维超声心动图变量难以区分 RVF 风险患者。我们检查了三维超声心动图（3DE）右心室（RV）容积评估识别 RVF 风险患者的效用。
RVF 定义为 LVAD 手术后需要 >14 天的正性肌力输注或需要双心室辅助装置支持。在 26 例患者中，从经胸 3DE 全容积数据集中盲法测量 RV 容积和射血分数（EF）。比较 RVF 患者和无 RVF 患者的基线变量和 3DE RV 指数。24 例患者接受了连续血流 LVAD，2 例需要双心室支持装置。10 例患者在 LVAD 植入后需要长时间使用正性肌力药物。与 RVF 相关的基线特征包括更高的右心房压力、更高的右心房压力与肺毛细血管楔压比值，以及更低的心指数和 RV 每搏功指数（RVSWI）。与 RVF 相关的超声心动图指数包括 3DE 索引 RV 舒张末期和收缩末期容积（RVEDVI 和 RVESVI）和 RV 射血分数（RVEF）。3DE 定量 RV 容积与 RVF 发展之间的关系独立于 RVSWI：RVEDVI：比值比（OR）1.16，95%置信区间（CI）1.00-1.33（P=0.04）；RVESVI：OR 1.14，95% CI 1.01-1.28（P=0.03）。
定量 3DE 是 LVAD 前 RV 评估的一种很有前途的方法。3DE 评估的 RV 容积是 LVAD 受体 RVF 的预测因子，独立于 RV 功能的血流动力学相关性。
