Nadziakiewicz P, Niklewski T, Szyguła-Jurkiewicz B, Pacholewicz J, Zakliczyński M, Przybyłowski P, Krauchuk A, Zembala M
Department of Cardiac Anaesthesia and Intensive Care SUM, Silesian Centre for Heart Diseases, Zabrze, Poland.
Department of Cardiac Surgery and Transplantation SUM, Silesian Centre for Heart Diseases, Zabrze, Poland.
Transplant Proc. 2018 Sep;50(7):2080-2084. doi: 10.1016/j.transproceed.2018.02.164. Epub 2018 Mar 15.
Left ventricular assist devices (LVADs) are used for treatment of end-stage heart failure. Outcomes are dependent on right ventricle (RV) function. Prediction of RV function after LVAD implantation is crucial for device selection and patient outcome. The aim of our study was to compare early LVAD course in patients with optimal and borderline echocardiographic parameters of RV function.
We retrospectively reviewed 24 male patients with LVAD implantation. The following echocardiographic data of RV function were collected: FAC (fractional area change) with optimal value > 20%, tricuspid annulus plane systolic excursion >15 mm, RV diameter < 50mm, and right-to-left ventricle ratio < 0.57 (RV/LV). Patients were divided into group 1 (12 patients) with transthoracic echocardiography parameters in optimal ranges and group 2 (12 patients) with suboptimal transthoracic echocardiography findings. Study endpoints were mortality, discharge from the intensive care unit, and RV dysfunction. Demographics, postoperative clinical outcomes, comorbidities, complications, and results in a 30-day period were analyzed between groups.
Echocardiography parameters differed significantly between groups 1 and 2 according to FAC (31.8% vs 24.08%; P = .005), RV4 (45.08 mm vs 51.69 mm; P = .02), and RV/LV ratio (0.6 vs 0.7; P = .009). Patients did not differ according to course of disease, comorbidities before implantation, or complications. One patient from each group died. Patients in group 2 experienced more pulmonary hypertension, required increased doses of catecholamines, and stayed in the intensive care unit longer. No RV dysfunction was noted.
Borderline FAC, tricuspid annulus plane systolic excursion, and RV4 add RV/LV ratio prolonged recovery after LVAD implantation even with no RV failure. Parameters chosen for qualification are in safe ranges.
左心室辅助装置（LVAD）用于治疗终末期心力衰竭。治疗结果取决于右心室（RV）功能。LVAD植入术后右心室功能的预测对于装置选择和患者预后至关重要。我们研究的目的是比较右心室功能超声心动图参数处于最佳和临界状态的患者早期LVAD治疗过程。
我们回顾性分析了24例接受LVAD植入的男性患者。收集了以下右心室功能的超声心动图数据：FAC（面积变化分数），最佳值>20%；三尖瓣环平面收缩期位移>15mm；右心室直径<50mm；右心室与左心室比值<0.57（RV/LV）。患者被分为第1组（12例），经胸超声心动图参数在最佳范围内；第2组（12例），经胸超声心动图检查结果欠佳。研究终点为死亡率、重症监护病房出院情况和右心室功能障碍。分析两组之间的人口统计学、术后临床结果、合并症、并发症以及30天内的结果。
根据FAC（31.8%对24.08%；P = 0.005）、RV4（45.08mm对51.69mm；P = 0.02）和RV/LV比值（0.6对0.7；P = 0.009），第1组和第2组的超声心动图参数存在显著差异。患者在疾病进程、植入前合并症或并发症方面无差异。每组各有1例患者死亡。第2组患者出现更多肺动脉高压，需要增加儿茶酚胺剂量，在重症监护病房停留时间更长。未发现右心室功能障碍。
临界FAC、三尖瓣环平面收缩期位移和RV4加上RV/LV比值即使在没有右心室衰竭的情况下也会延长LVAD植入术后的恢复时间。用于评估的参数处于安全范围内。
