Serial Echocardiography Using Tissue Doppler and Speckle Tracking Imaging to Monitor Right Ventricular Failure Before and After Left Ventricular Assist Device Surgery

Abstract

Objectives This study aimed to investigate the utility of serial tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) for monitoring right ventricular failure (RVF) after left ventricular assist device (LVAD) surgery. Background RVF post-LVAD is a devastating adverse event. Methods The authors prospectively studied 68 patients undergoing elective LVAD surgery. Echocardiograms were performed within 72 h before and 72 h after surgery. RVF was pre-specified as: 1) the need for salvage right ventricular assist device (RVAD); or 2) persistent need for inotrope and/or pulmonary vasodilator therapy 14 days after surgery. Patients were classified as Group RVF or Group Non-RVF. Results A total of 24 patients (35.3%) met criteria for RVF. Preoperative TDI-derived S’ was lower and RV E/E’ ratio was higher (3.7 ± 0.6 cm/s vs. 4.7 ± 0.9 cm/s, 12.0 ± 2.3 vs. 10.0 ± 2.5, both p < 0.001, respectively), and the absolute value of RV longitudinal strain (RV-strain) obtained from STE was lower (−12.6 ± 3.3% vs. −16.2 ± 4.3%, p < 0.001) in Group RVF vs. Group Non-RVF. Echo parameters within 72 h after surgery showed higher RV-E/E’, (13.9 ± 4.6 vs. 10.1 ± 3.0, p < 0.001) and lower RV-strain (−11.8 ± 3.5% vs. −16.7 ± 4.4%, p < 0.001) in Group RVF vs. Group Non-RVF. Preoperative S’ <4.4 cm/s, RV-E/E’>10 and RV-strain < −14% discriminated patients who developed RVF at day 14 with a predictive accuracy of 76.5%. When we included postoperative RV-E/E’ and RV-strain, the predictive accuracy increased to 80.9%, with a sensitivity of 66.7% and a specificity of 88.7%. Conclusions Serial echocardiograms using TDI and STE before and soon after LVAD surgery may aid in identifying need to initiate targeted RVF specific therapy in this population.

Right Ventricular Longitudinal Strain In Left Ventricular Assist Device Surgery–A Retrospective Cohort Study

“…11 Our sample of 57, would have provided 94% power to detect an odds ratio as small as 1.33 for a 1% decrease in RV strain, assuming RV strain is normally distributed (mean=−16%, SD=4%) and a 0.025 significance level for a one-sided test. All statistical tests were performed using SAS 9.4.…”

Validation of clinical scores for right ventricular failure prediction after implantation of continuous-flow left ventricular assist devices

“…Quantification of RV function with speckle tracking seems most promising, with several independent groups, including ours, reporting on the value of RV longitudinal strain as a strong independent predictor of RVF. [19][20][21][22] In the largest of these studies, RV longitudinal strain significantly refined prediction when added to the Michigan score (C statistic ¼ 0.77 vs 0.66). 19 Of note, the Michigan score findings in that study were similar to our findings.…”

A detailed evaluation of cardiac function in cirrhotic patients and its alteration with or without liver transplantation

“…The measurement of RV global longitudinal systolic strain using 2D speckle tracking analysis has been described previously [14,15]. Briefly, from the apical 4-chamber view, a region of interest (ROI) was manually traced along the endocardial border of the RV free wall and septal wall, and the width was set to match wall thickness.…”