Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program: University of Utah Health Sciences Center, Intermountain Medical Center, and Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah (M.J.B., A.K., O.W.-P., I.T., J.S., W.X., J.W.-P., A.C., J.N.-N., J.C.F., A.G.K., B.D.H., C.H.S., S.G.D.); Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece (M.J.B., S.N.A.); and Department of Cardiology, Leiden University Medical Center, Netherlands (J.J.B.); 3rd Department of Cardiology, National and Kapodistrian University of Athens , Athens, Greece (S.G.D.).
Circ Cardiovasc Imaging. 2018 Apr;11(4):e007117. doi: 10.1161/CIRCIMAGING.117.007117.
Impaired qualitative and quantitative left ventricular (LV) rotational mechanics predict cardiac remodeling progression and prognosis after myocardial infarction. We investigated whether cardiac rotational mechanics can predict cardiac recovery in chronic advanced cardiomyopathy patients.
Sixty-three patients with advanced and chronic dilated cardiomyopathy undergoing implantation of LV assist device (LVAD) were prospectively investigated using speckle tracking echocardiography. Acute heart failure patients were prospectively excluded. We evaluated LV rotational mechanics (apical and basal LV twist, LV torsion) and deformational mechanics (circumferential and longitudinal strain) before LVAD implantation. Cardiac recovery post-LVAD implantation was defined as (1) final resulting LV ejection fraction ≥40%, (2) relative LV ejection fraction increase ≥50%, (iii) relative LV end-systolic volume decrease ≥50% (all 3 required). Twelve patients fulfilled the criteria for cardiac recovery (Rec Group). The Rec Group had significantly less impaired pre-LVAD peak LV torsion compared with the Non-Rec Group. Notably, both groups had similarly reduced pre-LVAD LV ejection fraction. By receiver operating characteristic curve analysis, pre-LVAD peak LV torsion of 0.35 degrees/cm had a 92% sensitivity and a 73% specificity in predicting cardiac recovery. Peak LV torsion before LVAD implantation was found to be an independent predictor of cardiac recovery after LVAD implantation (odds ratio, 0.65 per 0.1 degrees/cm [0.49-0.87]; =0.014).
LV rotational mechanics seem to be useful in selecting patients prone to cardiac recovery after mechanical unloading induced by LVADs. Future studies should investigate the utility of these markers in predicting durable cardiac recovery after the explantation of the cardiac assist device.
左心室（LV）旋转力学的质量和数量受损可预测心肌梗死后心脏重构的进展和预后。我们研究了心脏旋转力学是否可以预测慢性晚期扩张型心肌病患者的心脏恢复情况。
前瞻性研究了 63 例接受 LV 辅助装置（LVAD）植入的晚期慢性扩张型心肌病患者，使用斑点追踪超声心动图进行评估。急性心力衰竭患者被前瞻性排除。我们在 LVAD 植入前评估 LV 旋转力学（心尖和基底 LV 扭转、LV 扭距）和变形力学（圆周和纵向应变）。LVAD 植入后的心脏恢复定义为（1）最终 LV 射血分数≥40%，（2）相对 LV 射血分数增加≥50%，（iii）相对 LV 收缩末期容积减少≥50%（所有 3 项均需满足）。12 名患者符合心脏恢复标准（Rec 组）。与 Non-Rec 组相比，Rec 组的 LVAD 植入前峰值 LV 扭距受损明显较轻。值得注意的是，两组的 LVAD 植入前 LV 射血分数均有降低。通过接受者操作特征曲线分析，LVAD 植入前峰值 LV 扭距 0.35 度/厘米时，对心脏恢复的预测有 92%的敏感性和 73%的特异性。LVAD 植入前峰值 LV 扭距被发现是 LVAD 植入后心脏恢复的独立预测因子（优势比，每 0.1 度/厘米增加 0.65[0.49-0.87]；=0.014）。
LV 旋转力学似乎可用于选择在 LVAD 机械卸载后易于心脏恢复的患者。未来的研究应探讨这些标志物在预测心脏辅助装置去除后持久心脏恢复中的效用。
