Department of Cardiac Surgery, Faculty of Medicine, RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany.
Department of Cardiothoracic Surgery, Heart Centre Trier, Barmherzigen Brueder Hospital, Trier, Germany.
ESC Heart Fail. 2024 Oct;11(5):3012-3022. doi: 10.1002/ehf2.14839. Epub 2024 Jun 5.
This study aimed to compare the changes in the left ventricle (LV) and right ventricle (RV) geometry and performance after the implantation of HeartMate II (HMII) and HeartMate 3 (HM3). In addition, we investigated whether the echocardiographic parameters LV sphericity index (LVSI) and the novel pressure-dimension index (PDI) can predict post-operative right ventricular failure (RVF).
Between 2012 and 2020, 46 patients [HMII (n = 22) and HM3 (n = 24)] met the study's criteria and had echocardiography tests pre-operatively, 6 and 12 months post-operatively. The LVSI and PDI were calculated together with the standard LV and RV echocardiographic parameters. The mean follow-up was 24 ± 7 months. In both groups, the LV end-diastolic diameter (LVEDD) significantly decreased 12 months post-operatively compared with the pre-operative values (HMII: 6.4 ± 1.4 cm vs. 5.7 ± 0.9 cm, P = 0.040; HM3: 6.7 ± 1.3 cm vs. 5.5 ± 0.9 cm, P < 0.01, respectively). RV function 12 months post-operatively was better in the HM3 group than in the HMII group, as indicated by a significantly higher RV fractional area change (RVFAC) in the HM3 group than in the HMII group 12 months post-operatively (35 ± 12% vs. 26 ± 16%, P = 0.039), significantly higher tricuspid annular plane systolic excursion (TAPSE) in the HM3 group 12 months post-operatively compared with the HMII group (13.9 ± 1.9 mm vs. 12.0 ± 2.1 mm, P = 0.002), and the tissue Doppler estimated tricuspid annular systolic velocity (TASV) was also significantly higher in the HM3 group 12 months post-operatively compared with the HMII group (11.5 ± 2.7 mm/s vs. 9.9 ± 1.5 mm/s, P = 0.020). The LVSI value was significantly higher 12 months post-operatively in the HMII group than in the HM3 group (1.2 ± 0.4 vs. 0.8 ± 0.2, P = 0.001, respectively), indicating worse geometric changes. The PDI decreased 12 months post-operatively in the HM3-group compared with the baseline (3.4 ± 1.4 mmHg/cm vs. 2.0 ± 0.8 mmHg/cm, P < 0.001). In the univariate and multivariate analyses, only the pre-operative PDI was a predictor of post-operative RVF [odds ratio: 3.84 (95% CI: 1.53-18.16, P = 0.022)]. The area under the curve for pre-operative PDI was 0.912. The 2 year survival was significantly better in the HM3 group (log-rank, P = 0.042).
The design of HM3 offered better geometrical preservation of the LV and enabled normal PDI values, leading to improved RV function, as indicated by better RVFAC, TAPSE, and TASV values. The use of pre-operative PDI as an additional tool for established risk scores might offer a better pre-operative predictor of RVF.
本研究旨在比较 HeartMate II (HMII) 和 HeartMate 3 (HM3) 植入后左心室 (LV) 和右心室 (RV) 几何形状和功能的变化。此外，我们还研究了超声心动图参数 LV 球形指数 (LVSI) 和新的压力-直径指数 (PDI) 是否可以预测术后右心衰竭 (RVF)。
2012 年至 2020 年间，46 例患者（HMII [n=22] 和 HM3 [n=24]）符合研究标准，并在术前、术后 6 个月和 12 个月进行了超声心动图检查。计算了 LVSI 和 PDI 以及标准的 LV 和 RV 超声心动图参数。平均随访时间为 24±7 个月。在两组中，LV 舒张末期直径（LVEDD）在术后 12 个月均显著小于术前值（HMII：6.4±1.4cm 比 5.7±0.9cm，P=0.040；HM3：6.7±1.3cm 比 5.5±0.9cm，P<0.01）。与 HMII 组相比，HM3 组术后 12 个月 RV 功能更好，表现为 HM3 组 RV 局部射血分数（RVFAC）显著高于 HMII 组（35±12%比 26±16%，P=0.039），HM3 组术后 12 个月三尖瓣环平面收缩期位移（TAPSE）显著高于 HMII 组（13.9±1.9mm 比 12.0±2.1mm，P=0.002），组织多普勒估计的三尖瓣环收缩期速度（TASV）也显著高于 HMII 组（11.5±2.7mm/s 比 9.9±1.5mm/s，P=0.020）。HMII 组术后 12 个月的 LVSI 值显著高于 HM3 组（1.2±0.4 比 0.8±0.2，P=0.001），表明几何形状变化更差。与基线相比，HM3 组术后 12 个月 PDI 降低（3.4±1.4mmHg/cm 比 2.0±0.8mmHg/cm，P<0.001）。在单因素和多因素分析中，只有术前 PDI 是术后 RVF 的预测因素[比值比：3.84（95%可信区间：1.53-18.16，P=0.022）]。术前 PDI 的曲线下面积为 0.912。HM3 组的 2 年生存率显著提高（对数秩检验，P=0.042）。
HM3 的设计提供了更好的 LV 几何形状保存，并使 PDI 值正常化，从而改善 RV 功能，表现为 RVFAC、TAPSE 和 TASV 值更好。将术前 PDI 作为既定风险评分的附加工具，可能会提供更好的 RVF 术前预测。
