Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan.
Artif Organs. 2020 Jul;44(7):700-708. doi: 10.1111/aor.13658. Epub 2020 Feb 24.
The spleen has been recognized as an important organ that holds a reserve of 20% to 30% of the total blood volume. Spleen contraction and splenic volume reduction occur in patients with hypovolemic shock. However, the change in the spleen volume and the association between spleen size and hemodynamic parameters remain unclear in patients with advanced heart failure (HF) who need left ventricular assist device (LVAD) support. This study was performed to investigate the change in spleen size and the relationship between spleen size and hemodynamic parameters before and after LVAD implantation in patients with advanced HF. We enrolled 20 patients with advanced HF on LVAD support. All patients underwent right heart catheterization and computed tomography before and after LVAD implantation. The spleen size was measured by computed tomography volumetry. We excluded patients with a mean right atrial pressure (RAP) of <5 mm Hg because of the possibility of hypovolemia and those with a cardiac index of >2.2 L/min/m before LVAD implantation. The splenic volume significantly increased from 160.6 ± 46.9 mL before LVAD implantation to 224.6 ± 73.5 mL after LVAD implantation (P < .001). Before LVAD implantation, there was a significant negative correlation between spleen volume and systemic vascular resistance (SVR). After LVAD implantation, however, there were significant correlations between spleen volume and the cardiac index, RAP, and pulmonary capillary wedge pressure despite the absence of a significant correlation between spleen volume and SVR. Furthermore, one patient developed reworsening HF because of LVAD failure due to pump thrombosis. In this case, the splenic volume was 212 mL before LVAD implantation and increased to 418 mL after LVAD implantation, although it decreased to 227 mL after LVAD failure. The spleen size may change depending on hemodynamics in patients with advanced HF with LVAD support, reflecting sympathetic nerve activity and the systemic volume status.
脾脏被认为是一个重要的器官，它储备了总血量的 20%至 30%。在低血容量性休克患者中，会出现脾脏收缩和脾脏体积减小。然而，在需要左心室辅助装置 (LVAD) 支持的晚期心力衰竭 (HF) 患者中，脾脏体积的变化以及脾脏大小与血流动力学参数之间的关系尚不清楚。本研究旨在探讨 LVAD 植入前后晚期 HF 患者脾脏大小的变化及其与血流动力学参数的关系。我们纳入了 20 名接受 LVAD 支持的晚期 HF 患者。所有患者在 LVAD 植入前后均接受了右心导管检查和计算机断层扫描。通过计算机断层扫描体积测量来测量脾脏大小。我们排除了平均右心房压 (RAP) <5mmHg 的患者，因为存在低血容量的可能性，以及 LVAD 植入前心脏指数 >2.2L/min/m 的患者。脾脏体积从 LVAD 植入前的 160.6 ± 46.9mL 显著增加到植入后的 224.6 ± 73.5mL（P<0.001）。在 LVAD 植入前，脾脏体积与全身血管阻力 (SVR) 呈显著负相关。然而，在 LVAD 植入后，尽管脾脏体积与 SVR 之间无显著相关性，但脾脏体积与心指数、RAP 和肺毛细血管楔压之间存在显著相关性。此外，有 1 例患者因 LVAD 血栓形成导致泵衰竭而出现 HF 恶化。在这种情况下，LVAD 植入前脾脏体积为 212mL，植入后增加到 418mL，尽管在 LVAD 故障后降至 227mL。LVAD 支持的晚期 HF 患者的脾脏大小可能会根据血流动力学而变化，反映交感神经活动和全身容量状态。
