Seuthe Katharina, Schuldes Benjamin, Rahmanian Parwis, Ten Freyhaus Henrik, Böttiger Bernd W, Wetsch Wolfgang A, Vandenheuvel Michael, Mauermann Eckhard, Labus Jakob
Department of Cardiology, Heart Center, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany.
Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany.
Semin Cardiothorac Vasc Anesth. 2025 Sep;29(3):182-191. doi: 10.1177/10892532251343169. Epub 2025 May 19.
The novel method of non-invasive right ventricular (RV) myocardial work (MW) analysis provides a load-independent assessment of RV function by combining myocardial strain with loading conditions. However, its use has not been well described in the perioperative setting to date. We aimed to evaluate the feasibility of assessing RV MW, and to describe the perioperative course of this new technique. In this retrospective study, patients scheduled for LVAD surgery were evaluated for feasibility of RV MW analysis. Preoperative (T1) and postoperative (T2) transthoracic echocardiography (TTE) included the assessment of conventional echocardiographic measurements, myocardial strain, global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) for the evaluation of RV function. Ten patients had complete TTE data available for RV MW analysis, which indicated significant reduction of effective and ineffective RV MW (GWI, 212 mmHg% (IQR 128; 266) v 96 mmHg% (IQR 63; 150), = 0.02; GCW, 331 mmHg% (IQR 263; 476) v 198 mmHg% (IQR 136; 274), < 0.01; GWW, 171 mmHg% (IQR 102; 243) v 98 mmHg% (IQR 48; 153), = 0.04), while GWE remained stable (69% (IQR 37; 78) v 64% (IQR 61; 78), = 0.26) after LVAD implantation. Conventional parameters were not able to detect these changes. Moreover, there were different trends of RV MW indices in patients with and without postimplant RV failure. This study demonstrates that non-invasive RV MW assessment is feasible in the perioperative setting of LVAD implantation and provides valuable insights into RV function that are not captured by conventional echocardiographic methods. Further research is warranted to validate these findings.
这种新型的无创右心室（RV）心肌做功（MW）分析方法，通过结合心肌应变与负荷条件，提供了一种与负荷无关的右心室功能评估方法。然而，迄今为止，其在围手术期的应用尚未得到充分描述。我们旨在评估评估右心室MW的可行性，并描述这项新技术的围手术期过程。在这项回顾性研究中，对计划进行左心室辅助装置（LVAD）手术的患者进行右心室MW分析的可行性评估。术前（T1）和术后（T2）经胸超声心动图（TTE）包括评估传统超声心动图测量、心肌应变、整体做功指数（GWI）、整体建设性做功（GCW）、整体无用功（GWW）和整体做功效率（GWE），以评估右心室功能。10例患者有完整的TTE数据可用于右心室MW分析，结果显示有效和无效右心室MW均显著降低（GWI，212mmHg%（四分位间距[IQR]128；266）对96mmHg%（IQR 63；150），P = 0.02；GCW，331mmHg%（IQR 263；476）对198mmHg%（IQR 136；274），P < 0.01；GWW，171mmHg%（IQR 102；243）对98mmHg%（IQR 48；153），P = 0.04），而LVAD植入后GWE保持稳定（69%（IQR 37；78）对64%（IQR 61；78），P = 0.26）。传统参数无法检测到这些变化。此外，有植入后右心室衰竭和无植入后右心室衰竭的患者右心室MW指数存在不同趋势。本研究表明，无创右心室MW评估在LVAD植入的围手术期是可行的，并提供了传统超声心动图方法未捕捉到的关于右心室功能的有价值见解。有必要进行进一步研究以验证这些发现。
