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Beck DR, Foley L, Rowe JR, Moss AFD, Weitzel NS, Reece TB, Fullerton DA, Cleveland JC, Bartels K. Right Ventricular Longitudinal Strain In Left Ventricular Assist Device Surgery-A Retrospective Cohort Study. J Cardiothorac Vasc Anesth 2017; 31:2096-2102. [PMID: 29103855 DOI: 10.1053/j.jvca.2017.07.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Right ventricular (RV) failure is common after left ventricular assist device (LVAD) surgery and is associated with higher mortality. Measurement of longitudinal RV strain using speckle-tracking technology is a novel approach to quantify RV function. The authors hypothesized that depressed peak longitudinal RV strain measured by intraoperative transesophageal echocardiography (TEE) examinations would be associated with adverse outcomes after LVAD surgery. DESIGN Retrospective cohort study. SETTING Tertiary academic medical center. PARTICIPANTS Following Institutional Review Board approval, the authors retrospectively identified adult patients who underwent implantation of non-pulsatile LVAD. Exclusion criteria included inadequate TEE images and device explantation within 6 months for heart transplantation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The postoperative adverse event outcome was defined as a composite of one or more of death within 6 months, ≥14 days of inotropes, mechanical RV support, or device thrombosis. Intraoperative TEE images were analyzed for peak RV free wall longitudinal strain by two blinded investigators. Simple logistic regression was used to assess the relationship between adverse outcome and the mean of the strain measurements of the two raters. Agreement between the raters was assessed by intra-class correlation (0.62) and Pearson correlation coefficient (0.63). Of the 57 subjects, 21 (37%) had an adverse outcome. The logistic regression indicated no significant association between RV peak longitudinal strain and adverse events. CONCLUSIONS In this retrospective study of patients undergoing non-pulsatile LVAD implantation, peak longitudinal strain of the RV free wall was not associated with adverse outcomes within 6 months after surgery. Additional quantitative echocardiographic measures for intraoperative RV assessment should be explored.
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Affiliation(s)
- Daniel R Beck
- Department of Anesthesiology, University of Colorado Denver, School of Medicine, Aurora, CO; VA Eastern Colorado Healthcare, Denver, CO
| | - Lisa Foley
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Denver, School of Medicine, Aurora, CO
| | - Jackson R Rowe
- Department of Anesthesiology, University of Colorado Denver, School of Medicine, Aurora, CO
| | - Angela F D Moss
- Adult and Child Center for Health Outcomes and Delivery Science, University of Colorado, School of Medicine, Aurora, CO
| | - Nathaen S Weitzel
- Department of Anesthesiology, University of Colorado Denver, School of Medicine, Aurora, CO
| | - T Brett Reece
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Denver, School of Medicine, Aurora, CO
| | - David A Fullerton
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Denver, School of Medicine, Aurora, CO
| | - Joseph C Cleveland
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Denver, School of Medicine, Aurora, CO
| | - Karsten Bartels
- Department of Anesthesiology, University of Colorado Denver, School of Medicine, Aurora, CO.
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Rossini L, Martinez-Legazpi P, Vu V, Fernández-Friera L, Pérez Del Villar C, Rodríguez-López S, Benito Y, Borja MG, Pastor-Escuredo D, Yotti R, Ledesma-Carbayo MJ, Kahn AM, Ibáñez B, Fernández-Avilés F, May-Newman K, Bermejo J, Del Álamo JC. A clinical method for mapping and quantifying blood stasis in the left ventricle. J Biomech 2015; 49:2152-2161. [PMID: 26680013 DOI: 10.1016/j.jbiomech.2015.11.049] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 11/07/2015] [Indexed: 11/30/2022]
Abstract
In patients at risk of intraventrcular thrombosis, the benefits of chronic anticoagulation therapy need to be balanced with the pro-hemorrhagic effects of therapy. Blood stasis in the cardiac chambers is a recognized risk factor for intracardiac thrombosis and potential cardiogenic embolic events. In this work, we present a novel flow image-based method to assess the location and extent of intraventricular stasis regions inside the left ventricle (LV) by digital processing flow-velocity images obtained either by phase-contrast magnetic resonance (PCMR) or 2D color-Doppler velocimetry (echo-CDV). This approach is based on quantifying the distribution of the blood Residence Time (TR) from time-resolved blood velocity fields in the LV. We tested the new method in illustrative examples of normal hearts, patients with dilated cardiomyopathy and one patient before and after the implantation of a left ventricular assist device (LVAD). The method allowed us to assess in-vivo the location and extent of the stasis regions in the LV. Original metrics were developed to integrate flow properties into simple scalars suitable for a robust and personalized assessment of the risk of thrombosis. From a clinical perspective, this work introduces the new paradigm that quantitative flow dynamics can provide the basis to obtain subclinical markers of intraventricular thrombosis risk. The early prediction of LV blood stasis may result in decrease strokes by appropriate use of anticoagulant therapy for the purpose of primary and secondary prevention. It may also have a significant impact on LVAD device design and operation set-up.
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Affiliation(s)
- Lorenzo Rossini
- Mechanical and Aerospace Engineering Department, University of California San Diego, La Jolla, CA 92093, United States
| | - Pablo Martinez-Legazpi
- Mechanical and Aerospace Engineering Department, University of California San Diego, La Jolla, CA 92093, United States; Department of Cardiology, Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Department of Mechanical Engineering, San Diego State University, San Diego, CA 92182, United States.
| | - Vi Vu
- Department of Mechanical Engineering, San Diego State University, San Diego, CA 92182, United States
| | | | - Candelas Pérez Del Villar
- Department of Cardiology, Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Sara Rodríguez-López
- Biomedical Image Technologies, Universidad Politécnica de Madrid & CIBER-BBN, Spain
| | - Yolanda Benito
- Department of Cardiology, Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - María-Guadalupe Borja
- Mechanical and Aerospace Engineering Department, University of California San Diego, La Jolla, CA 92093, United States
| | | | - Raquel Yotti
- Department of Cardiology, Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | - Andrew M Kahn
- Department of Medicine, University of California San Diego, La Jolla, CA 92037, United States
| | - Borja Ibáñez
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Karen May-Newman
- Department of Mechanical Engineering, San Diego State University, San Diego, CA 92182, United States
| | - Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Juan C Del Álamo
- Mechanical and Aerospace Engineering Department, University of California San Diego, La Jolla, CA 92093, United States; Institute for Engineering in Medicine, University of California San Diego, La Jolla, CA 92093, United States
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