Relationship between right ventricular myocardial strain and early-stage right heart failure after left ventricular assist device implantation

doi:10.3877/cma.j.issn.1674-6880.2024.01.004

Abstract

Abstract:

Objective

To preliminarily investigate the effect of right ventricular myocardial strain on the occurrence of acute right heart failure (RHF) in patients after left ventricular assist device (LVAD) implantation.

Methods

A total of 20 patients with heart failure who underwent LVAD implantation from April 2022 to May 2023 at the First Affiliated Hospital of Xi'an Jiaotong University were consecutively included. All patients underwent routine transthoracic echocardiography before LVAD implantation. Parameters of left heart function and right heart function were obtained. Patients were divided into a no-RHF group (15 patients) and a RHF group (5 patients) according to whether RHF occurred after LVAD implantation. Right ventricular free wall longitudinal strain (RVFWSL) and right ventricle four-chamber longitudinal strain (RV4CSL) were obtained using two-dimensional speckle tracking echocardiography. Multifactorial logistic regression analysis was used to explore the factors affecting RHF after LVAD implantation.

Results

The left ventricular ejection fraction (LVEF) [(19 ± 6)% vs. (27 ± 4)%, t = 2.674, P = 0.040], right ventricular end-systolic volume (RVESV) [(60 ± 26) mL vs. (28 ± 18) mL, t = 3.074, P = 0.007], right ventricular ejection fraction (RVEF) [(27 ± 13)% vs. (50 ± 12)%, t = 3.635, P = 0.002], right ventricular fractional area change (RVFAC) [(22 ± 5)% vs. (34 ± 7)%, t = 3.776, P = 0.002], RVFWSL [(11.9 ± 2.1)% vs. (23.0 ± 6.9)%, t = 3.446, P = 0.003] and RV4CSL [(11.4 ± 2.8)% vs. (20.8 ± 6.8)%, t = 2.944, P = 0.009] in the RHF and no-RHF groups showed statistically significant differences. Multifactorial logistic regression analysis showed that the RVEF [odds ratio (OR) = 0.872, 95% confidence interval (CI) (0.773, 0.984), P = 0.041], RVFAC [OR = 0.779, 95%CI (0.589, 0.930), P = 0.045], RVFWSL [OR = 0.530, 95%CI (0.286, 0.982), P = 0.040] and RV4CSL [OR = 0.667, 95%CI (0.454, 0.979), P = 0.041] were the factors influencing RHF after LVAD implantation. It is suggested that the worse the overall right ventricular systolic function is, the more likely the patient is to develop RHF after LVAD implantation.

Conclusions

The lower the traditional right ventricular systolic function parameters of RVEF and RVFAC and the right ventricular strain parameters of RVFWSL and RV4CSL, the greater the likelihood of early RHF after LVAD implantation in patients with end-stage heart failure. For patients with preserved overall right ventricular systolic function, the combination of right ventricular strain parameters will provide to some extent finer-grained right ventricular systolic function parameters and improve the accuracy of LVAD selection.

Key words: Right heart failure, Left ventricular assist device, Echocardiography, Speckle tracking, Strain

Hong Chen, Litao Ruan, Tao Shi, Fengwei Guo, Junjun Hao, Yang Yan, Jianan Shang, Yan Song. Relationship between right ventricular myocardial strain and early-stage right heart failure after left ventricular assist device implantation[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2024, 17(01): 26-31.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhwzzyxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6880.2024.01.004

https://zhwzzyxzz.cma-cmc.com.cn/EN/Y2024/V17/I01/26

Figures/Tables 3

References 20

1	Greene SJ, Fonarow GC, Butler J. Risk profiles in heart failure: baseline, residual, worsening, and advanced heart failure risk[J]. Circ Heart Fail, 2020, 13 (6): e007132.
2	Crespo-Leiro MG, Metra M, Lund LH, et al. Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology[J]. Eur J Heart Fail, 2018, 20 (11): 1505-1535.
3	Mehra MR, Canter CE, Hannan MM, et al. The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: a 10-year update[J]. J Heart Lung Transplant, 2016, 35 (1): 1-23.
4	Han JJ, Acker MA, Atluri P. Left ventricular assist devices[J]. Circulation, 2018, 138 (24): 2841-2851.
5	Virani SS, Alonso A, Benjamin EJ, et al. Heart disease and stroke statistics-2020 update: a report from the American Heart Association[J]. Circulation, 2020, 141 (9): e139-e596.
6	Kormos RL, Antonides CFJ, Goldstein DJ, et al. Updated definitions of adverse events for trials and registries of mechanical circulatory support: a consensus statement of the mechanical circulatory support academic research consortium[J]. J Heart Lung Transplant, 2020, 39 (8): 735-750.
7	Birati EY, Rame JE. Post-heart transplant complications[J]. Crit Care Clin, 2014, 30 (3): 629-637.
8	Birati EY, Jessup M. Left ventricular assist devices in the management of heart failure[J]. Card Fail Rev, 2015, 1 (1): 25-30.
9	Sciaccaluga C, Soliman-Aboumarie H, et al. Echocardiography for left ventricular assist device implantation and evaluation: an indispensable tool[J]. Heart Fail Rev, 2022, 27 (3): 891-902.
10	Farrar DJ, Compton PG, Hershon JJ, et al. Right heart interaction with the mechanically assisted left heart[J]. World J Surg, 1985, 9 (1): 89-102.
11	Moon MR, Bolger AF, DeAnda A, et al. Septal function during left ventricular unloading[J]. Circulation, 1997, 95 (5): 1320-1327.
12	Morgan JA, Paone G, Nemeh HW, et al. Impact of continuous-flow left ventricular assist device support on right ventricular function[J]. J Heart Lung Transplant, 2013, 32 (4): 398-403.
13	Peura JL, Colvin-Adams M, Francis GS, et al. Recommendations for the use of mechanical circulatory support: device strategies and patient selection: a scientific statement from the American Heart Association[J]. Circulation, 2012, 126 (22): 2648-2667.
14	Kato TS, Jiang J, Schulze PC, et al. Serial echocardiography using tissue Doppler and speckle tracking imaging to monitor right ventricular failure before and after left ventricular assist device surgery[J]. JACC Heart Fail, 2013, 1 (3): 216-222.
15	Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging[J]. J Am Soc Echocardiogr, 2015, 28 (1): 1-39.e14.
16	Pavelescu A, Naeije R. Effects of epoprostenol and sildenafil on right ventricular function in hypoxic volunteers: a tissue Doppler imaging study[J]. Eur J Appl Physiol, 2012, 112 (4): 1285-1294.
17	Mercer-Rosa L, Parnell A, Forfia PR, et al. Tricuspid annular plane systolic excursion in the assessment of right ventricular function in children and adolescents after repair of Tetralogy of Fallot[J]. J Am Soc Echocardiogr, 2013, 26 (11): 1322-1329.
18	Fine NM, Chen L, Bastiansen PM, et al. Outcome prediction by quantitative right ventricular function assessment in 575 subjects evaluated for pulmonary hypertension[J]. Circ Cardiovasc Imaging, 2013, 6 (5): 711-721.
19	Hamada-Harimura Y, Seo Y, Ishizu T, et al. ICAS-HF investigators: incremental prognostic value of right ventricular strain in patients with acute decompensated heart failure[J]. Circ Cardiovasc Imaging, 2018, 11 (10): e007249.
20	Morris DA, Krisper M, Nakatani S, et al. Normal range and usefulness of right ventricular systolic strain to detect subtle right ventricular systolic abnormalities in patients with heart failure: a multicentre study[J]. Eur Heart J Cardiovasc Imaging, 2017, 18 (2): 212-223.

组别	例数	年龄（岁， ± s）	性别（例，男/女）	收缩压（mmHg， ± s）	舒张压（mmHg， ± s）	乳酸脱氢酶（U/L）	肌酸激酶（U/L）	肌酸激酶同工酶（U/L， ± s）	Pro-BNP（ng/L）	ICU住院时间（d）	总住院时间（d）
无RHF组	15	55 ± 11	12/3	105 ± 20	68 ± 14	244.0（198.0，371.0）	44.0（39.0，230.0）	13 ± 8	4 301（1 380，7 230）	8.0（5.0，10.0）	32.0（30.0，41.0）
RHF组	5	59 ± 6	5/0	94 ± 5	65 ± 7	268.0（231.5，991.0）	46.0（34.5，67.0）	11 ± 4	10 900（5 055，35 000）	8.0（4.0，28.5）	27.0（12.0，76.5）
t/χ²/Z值		0.736	1.176	1.087	0.475	0.963	0.453	0.469	1.967	11.111	20.000
P值		0.471	0.278	0.291	0.641	0.377	0.661	0.646	0.053	0.800	0.142

组别	例数	年龄（岁， ± s）	性别（例，男/女）	收缩压（mmHg， ± s）	舒张压（mmHg， ± s）	乳酸脱氢酶（U/L）	肌酸激酶（U/L）	肌酸激酶同工酶（U/L， ± s）	Pro-BNP（ng/L）	ICU住院时间（d）	总住院时间（d）
无RHF组	15	55 ± 11	12/3	105 ± 20	68 ± 14	244.0（198.0，371.0）	44.0（39.0，230.0）	13 ± 8	4 301（1 380，7 230）	8.0（5.0，10.0）	32.0（30.0，41.0）
RHF组	5	59 ± 6	5/0	94 ± 5	65 ± 7	268.0（231.5，991.0）	46.0（34.5，67.0）	11 ± 4	10 900（5 055，35 000）	8.0（4.0，28.5）	27.0（12.0，76.5）
t/χ²/Z值		0.736	1.176	1.087	0.475	0.963	0.453	0.469	1.967	11.111	20.000
P值		0.471	0.278	0.291	0.641	0.377	0.661	0.646	0.053	0.800	0.142

组别	例数	LVEDD（mm）	LVESD（mm）	LVEF（%）	每搏量（mL）	心输出量（L）	LV4CSL（%）	D_RVB（mm）	D_RVM（mm）	RVEDV（mL）
无RHF组	15	73 ± 12	65 ± 12	27 ± 4	51 ± 19	3.7 ± 1.3	-（7.3 ± 2.7）	38 ± 11	30 ± 8	51 ± 29
RHF组	5	77 ± 7	69 ± 10	19 ± 6	42 ± 7	3.2 ± 1.1	-（6.3 ± 2.4）	45 ± 10	36 ± 7	76 ± 25
t/Z值		0.618	0.696	2.674	1.029	0.902	0.710	1.265	1.586	1.727
P值		0.544	0.495	0.040	0.317	0.379	0.487	0.222	0.130	0.101
组别	例数	RVESV（mL）	RVEF（%）	s’（cm/s）	TAPSE（mm）	RVFAC（%）	PASP（mmHg）	RVFWSL（%）	RV4CSL（%）	下腔静脉内径（mm）
无RHF组	15	28 ± 18	50 ± 12	10.5 ± 2.9	17.4 ± 4.0	34 ± 7	37 ± 18	23.0 ± 6.9	20.8 ± 6.8	15.0（9.0，23.0）
RHF组	5	60 ± 26	27 ± 13	8.7 ± 1.2	14.6 ± 2.2	22 ± 5	53 ± 14	11.9 ± 2.1	11.4 ± 2.8	21.0（19.0，22.5）
t/Z值		3.074	3.635	1.364	1.460	3.776	1.863	3.446	2.944	1.185
P值		0.007	0.002	0.189	0.162	0.002	0.079	0.003	0.009	0.266

组别	例数	LVEDD（mm）	LVESD（mm）	LVEF（%）	每搏量（mL）	心输出量（L）	LV4CSL（%）	D_RVB（mm）	D_RVM（mm）	RVEDV（mL）
无RHF组	15	73 ± 12	65 ± 12	27 ± 4	51 ± 19	3.7 ± 1.3	-（7.3 ± 2.7）	38 ± 11	30 ± 8	51 ± 29
RHF组	5	77 ± 7	69 ± 10	19 ± 6	42 ± 7	3.2 ± 1.1	-（6.3 ± 2.4）	45 ± 10	36 ± 7	76 ± 25
t/Z值		0.618	0.696	2.674	1.029	0.902	0.710	1.265	1.586	1.727
P值		0.544	0.495	0.040	0.317	0.379	0.487	0.222	0.130	0.101
组别	例数	RVESV（mL）	RVEF（%）	s’（cm/s）	TAPSE（mm）	RVFAC（%）	PASP（mmHg）	RVFWSL（%）	RV4CSL（%）	下腔静脉内径（mm）
无RHF组	15	28 ± 18	50 ± 12	10.5 ± 2.9	17.4 ± 4.0	34 ± 7	37 ± 18	23.0 ± 6.9	20.8 ± 6.8	15.0（9.0，23.0）
RHF组	5	60 ± 26	27 ± 13	8.7 ± 1.2	14.6 ± 2.2	22 ± 5	53 ± 14	11.9 ± 2.1	11.4 ± 2.8	21.0（19.0，22.5）
t/Z值		3.074	3.635	1.364	1.460	3.776	1.863	3.446	2.944	1.185
P值		0.007	0.002	0.189	0.162	0.002	0.079	0.003	0.009	0.266

变量	回归系数	标准误	Wald值	OR值	95%CI	P值
LVEF	-0.513	0.297	2.982	0.599	0.334 ~ 1.072	0.084
RVESV	0.150	0.091	2.744	1.162	0.973 ~ 1.388	0.098
RVEF	-0.136	0.062	4.907	0.872	0.773 ~ 0.984	0.041
RVFAC	-0.250	0.143	3.080	0.779	0.589 ~ 0.930	0.045
RVFWSL	-0.636	0.315	4.069	0.530	0.286 ~ 0.982	0.040
RV4CSL	-0.405	0.196	4.269	0.667	0.454 ~ 0.979	0.041

Please choose a citation manager

Content to export