Author + information
- Received November 26, 2012
- Revision received January 28, 2013
- Accepted February 4, 2013
- Published online June 1, 2013.
- Tomoko Sugiyama Kato, MD, PhD∗,
- Jeffrey Jiang, BS∗,
- Paul Christian Schulze, MD, PhD∗,
- Ulrich Jorde, MD∗,
- Nir Uriel, MD∗,
- Shuichi Kitada, MD, PhD∗,
- Hiroo Takayama, MD, PhD†,
- Yoshifumi Naka, MD, PhD†,
- Donna Mancini, MD∗,
- Linda Gillam, MD‡,
- Shunichi Homma, MD∗ and
- Maryjane Farr, MD, MSc∗∗ ()
- ↵∗Reprint requests and correspondence Dr. Maryjane Farr, Columbia University Medical Center, Department of Medicine, Division of Cardiology, Center for Advanced Cardiac Care, 622 West 168th Street, PH 1273, New York, New York 10032.
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.
Dr. Farr was supported by National Center for Advancing Translational Sciences (formerly, National Center for Research Resources), National Institutes of Health, grant UL1 TR00040. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 26, 2012.
- Revision received January 28, 2013.
- Accepted February 4, 2013.
- American College of Cardiology Foundation