Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
J Card Surg. 2021 Jun;36(6):1996-2003. doi: 10.1111/jocs.15479. Epub 2021 Apr 8.
The aim of this study is to evaluate the predictive utility of preoperative right ventricular (RV) global longitudinal strain (GLS) and free wall strain (FWS) on outcomes following left ventricular assist devices (LVADs) implantation.
Preoperative transthoracic echocardiograms were retrospectively reviewed in adults undergoing continuous-flow LVAD implantation between 2004 and 2018 at a single center. Patients undergoing pump exchange were excluded. RV GLS and FWS were calculated using commercially available software with the apical four-chamber view. The primary outcome was RV failure as defined by the Interagency Registry for Mechanically Assisted Circulatory Support within 1-year post-LVAD insertion.
A total of 333 patients underwent continuous-flow LVAD implantation during the study period and 137 had adequate preoperative studies for RV strain evaluation. RV FWS was found to be a significant predictor of postoperative RV failure in univariate analysis (odds ratio [OR] = 1.12, p = .03), and this finding persisted after risk adjustment in multivariable analysis (OR = 1.14, p = .04). Using the optimal cutoff value of -5.64%, the c-index of FWS in predicting RV failure was 0.65. RV GLS was not associated with post-LVAD RV failure (OR = 1.07, p = .29). PCWP was the only additional significant predictor of RV failure using multivariable analysis (OR = 0.90, p = .02).
Pre-implant RV FWS is predictive of RV failure in the first postoperative year after LVAD implantation.
本研究旨在评估术前右心室（RV）整体纵向应变（GLS）和游离壁应变（FWS）对左心室辅助装置（LVAD）植入后结局的预测价值。
回顾性分析 2004 年至 2018 年间在单一中心接受连续血流 LVAD 植入的成人患者的经胸超声心动图。排除接受泵置换的患者。使用商业软件和心尖四腔心切面计算 RV GLS 和 FWS。主要结局是 LVAD 植入后 1 年内定义的 RV 衰竭，由机械循环支持机构间注册中心定义。
研究期间共有 333 例患者接受了连续血流 LVAD 植入，其中 137 例患者术前 RV 应变评估有足够的研究资料。单因素分析发现 RV FWS 是术后 RV 衰竭的显著预测因素（优势比[OR] = 1.12，p = .03），多因素分析后这一发现仍然存在（OR = 1.14，p = .04）。使用最佳截断值-5.64%，FWS 预测 RV 衰竭的 C 指数为 0.65。RV GLS 与 LVAD 后 RV 衰竭无关（OR = 1.07，p = .29）。多因素分析显示，仅肺动脉楔压（PCWP）是 RV 衰竭的另一个显著预测因素（OR = 0.90，p = .02）。
植入前 RV FWS 可预测 LVAD 植入后第 1 年 RV 衰竭。
