Thoraxcenter, Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Cardiothoracic Surgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
Echocardiography. 2022 Jan;39(1):7-19. doi: 10.1111/echo.15191. Epub 2021 Dec 8.
Right ventricular (RV) failure post left ventricular assist device (LVAD) implantation is associated with increased morbidity and mortality. A novel RV multi-plane imaging method using two-dimensional echocardiography and electronic plane rotation (MPE) was used to quantify RV function prior to LVAD implantation and to identify potential added value in this patient population.
In twenty-five end-stage heart failure patients (age 58.9 ± 6.8 years, 76% male), systolic function of four different RV walls (lateral, anterior, inferior and inferior coronal) were evaluated from one focussed apical view using MPE.
Feasibility of tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular peak systolic velocity (RV-S') measurements were high (84-100%), with lower TAPSE values measured in the inferior (14.2 ± 4.6 mm) and inferior coronal (12.3 ± 5.0 mm) walls compared to the lateral (16.3 ± 4.5 mm) and anterior walls (16.0 ± 4.5 mm). RV wall longitudinal strain (RV-LS) measurement was most feasible in the lateral wall (80%; mean: -12.1 ± 4.2%). TAPSE and RV-LS values were significantly reduced in patients compared to matched healthy individuals (p = <0.001). Seven (28%) patients who developed moderate to severe RV failure (RVF) early post-implant (≤30 days) had lower pre-implant values across all multi-plane parameters compared to those without significant post-implant RVF, notably four-wall averaged TAPSE (11.1 ± 3.4 mm vs 15.9 ± 4.0 mm; p = 0.02).
2D MPE was highly feasible for RV wall quantification pre-LVAD surgery, detecting differences in regional wall function. This novel method comprehensively quantifies RV wall function and could complement current pre-LVAD screening protocols.
左心室辅助装置（LVAD）植入后右心室（RV）衰竭与发病率和死亡率增加相关。一种使用二维超声心动图和电子平面旋转（MPE）的新型 RV 多平面成像方法，用于在 LVAD 植入前量化 RV 功能，并确定该患者群体的潜在附加价值。
在 25 例终末期心力衰竭患者（年龄 58.9±6.8 岁，76%为男性）中，使用 MPE 从一个集中的心尖视图评估四个不同 RV 壁（侧壁、前壁、下壁和下冠状壁）的收缩功能。
三尖瓣环平面收缩期位移（TAPSE）和三尖瓣环收缩期峰值速度（RV-S'）测量的可行性很高（84-100%），下壁（14.2±4.6mm）和下冠状壁（12.3±5.0mm）的 TAPSE 值低于侧壁（16.3±4.5mm）和前壁（16.0±4.5mm）。RV 壁纵向应变（RV-LS）测量在侧壁最可行（80%；平均值：-12.1±4.2%）。与匹配的健康个体相比，患者的 TAPSE 和 RV-LS 值显着降低（p<0.001）。7 例（28%）患者在植入后早期（≤30 天）发生中度至重度 RV 衰竭（RVF），与无明显植入后 RVF 的患者相比，所有多平面参数的植入前值均较低，尤其是四壁平均 TAPSE（11.1±3.4mm 与 15.9±4.0mm；p=0.02）。
2D MPE 在 LVAD 手术前对 RV 壁定量非常可行，可检测到局部壁功能的差异。这种新方法全面量化 RV 壁功能，并可补充当前的 LVAD 前筛查方案。
