轴流辅助装置植入后早期左心室尺寸减小指数：晚期泵血栓形成的一种新型风险标志物。
Left ventricular dimension decrement index early after axial flow assist device implantation: A novel risk marker for late pump thrombosis.
作者信息
Joyce Emer, Stewart Garrick C, Hickey Maryclare, Coakley Lara, Rivero Jose M, Gosev Igor, Givertz Michael M, Couper Gregory S, Mehra Mandeep R
机构信息
Center for Advanced Heart Disease, Brigham and Women's Hospital Heart and Vascular Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Center for Advanced Heart Disease, Brigham and Women's Hospital Heart and Vascular Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
出版信息
J Heart Lung Transplant. 2015 Dec;34(12):1561-9. doi: 10.1016/j.healun.2015.08.020. Epub 2015 Sep 15.
BACKGROUND
It is increasingly recognized that pump thrombosis most likely represents the end stage of a complex interaction between the patient-pump interface. We hypothesized that early patient/pump mismatch, as manifested by suboptimal left ventricular (LV) unloading early after left ventricular assist device (LVAD) implantation, may be a harbinger of increased risk for later LVAD thrombosis.
METHODS
In 64 patients (59 ± 11 years old, 78% men, 44% destination therapy) discharged alive without thrombosis or other device malfunction after first HeartMate II LVAD implantation (between January 2011 and June 2014), LV dimensions in end diastole (LVIDd) and end systole (LVIDs) were compared between pre-implant and optimal set speed pre-discharge echocardiography. LV dimension decrement indices (pre-implant dimension - optimal set speed dimension ÷ pre-implant dimension × 100) for LVIDd [LVIDdDI] and LVIDs [LVIDsDI] were calculated.
RESULTS
The incidence of pump thrombosis was 0.06 per patient year (n = 18, median time 8 [interquartile range 2, 17] months). Baseline characteristics including pre-operative LVIDd and LVIDs were similar between LVAD thrombosis and no thrombosis groups. After ventricular assist device implantation, set speed and other ramp parameters did not differ between groups. However, LVIDdDI (19 ± 13% vs 25 ± 11%, p = 0.04) and LVIDsDI (16 ± 16% vs 27 ± 13%, p = 0.008) were significantly lower in patients with later pump thrombosis. A cutoff value of ≤15% using receiver operating characteristic curve analysis was 83% sensitive for LVIDdDI and LVIDsDI for predicting pump thrombosis. Patients with LVIDdDI of >15% vs ≤15% were significantly more likely to be free of pump thrombosis over a median follow-up period of 15 (interquartile range 9, 26) months (log-rank test, p = 0.045).
CONCLUSIONS
LV dimension decrement index at optimized speed setting on pre-discharge echocardiography is associated with LVAD thrombosis.
背景
人们越来越认识到，泵血栓形成很可能代表了患者与泵界面之间复杂相互作用的终末期。我们假设，左心室辅助装置（LVAD）植入后早期出现的患者/泵不匹配，表现为左心室（LV）卸载不理想，可能是后期LVAD血栓形成风险增加的先兆。
方法
在64例首次植入HeartMate II LVAD（2011年1月至2014年6月）后存活出院且无血栓形成或其他装置故障的患者（年龄59±11岁，78%为男性，44%为目标治疗）中，比较植入前和出院前最佳设定速度时超声心动图的舒张末期（LVIDd）和收缩末期（LVIDs）左心室尺寸。计算LVIDd[LVIDdDI]和LVIDs[LVIDsDI]的左心室尺寸减小指数（植入前尺寸 - 最佳设定速度尺寸÷植入前尺寸×100）。
结果
泵血栓形成的发生率为每年0.06例患者（n = 18，中位时间8[四分位间距2, 17]个月）。LVAD血栓形成组和无血栓形成组的基线特征包括术前LVIDd和LVIDs相似。心室辅助装置植入后，两组的设定速度和其他斜坡参数无差异。然而，后期发生泵血栓形成的患者的LVIDdDI（19±13%对25±11%，p = 0.04）和LVIDsDI（16±16%对27±13%，p = 0.008）显著更低。使用受试者工作特征曲线分析，LVIDdDI和LVIDsDI预测泵血栓形成的临界值≤15%时敏感度为83%。在中位随访期15（四分位间距9, 26）个月内，LVIDdDI>15%与≤15%的患者相比，无泵血栓形成的可能性显著更高（对数秩检验，p = 0.045）。
结论
出院前超声心动图在优化速度设定时的左心室尺寸减小指数与LVAD血栓形成有关。
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