Evaluation of right ventricular function and post-operative findings using cardiac computed tomography in patients with left ventricular assist devices

Ana Garcia-Alvarez, Leticia Fernandez-Friera, Joe F. Lau, Simonette T. Sawit, Jesus G. Mirelis, Javier G. Castillo, Sean Pinney, Anelechi C. Anyanwu, Valentin Fuster, Javier Sanz, Mario J. Garcia

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background: Right ventricular (RV) failure is a major contributor to morbidity and mortality after left ventricular assist device (LVAD) implantation. Accurate evaluation of RV function in patients with LVAD remains challenging. We hypothesized that, after LVAD implantation, electrocardiographic-gated cardiac computed tomography (CCT) allows RV evaluation with higher feasibility and reproducibility compared with echocardiography. Methods: Thirty-six patients with an implanted LVAD who had 2-dimensional echocardiography and CCT evaluation were studied. RV end-diastolic and end-systolic volumes and ejection fraction were quantified using CCT. RV fractional area change, tricuspid annular plane systolic excursion and RV end-diastolic short-to-long axis ratio were calculated by echocardiography. Intraclass correlation coefficients (ICCs) and BlandAltman analysis were used to assess intra- and interobserver reproducibility for all measurements. Results: The quality of CCT studies was good in all cases except for one. Intra- and interobserver reproducibility for all CCT measurements was high (interobserver ICC for RV ejection fraction = 0.89, 95% confidence interval 0.74 to 0.95). Echocardiographic indices of RV function and geometry had lower reproducibility. The echocardiographic index that best correlated with the CCT-determined RV ejection fraction was RV fractional area change (r = 0.80, p < 0.001). In addition, CCT detected relevant post-operative findings in 50% of the patients. Conclusions: CCT is highly effective and reproducible compared with echocardiography for the evaluation of RV function in patients with LVAD support and provides relevant information on post-operative findings. Our results suggest that CCT should be considered as a useful imaging modality in this clinical setting.

Original languageEnglish (US)
Pages (from-to)896-903
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume30
Issue number8
DOIs
StatePublished - Aug 2011

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Right Ventricular Function
Heart-Assist Devices
Tomography
Echocardiography
Stroke Volume
Confidence Intervals
Morbidity
Mortality

Keywords

  • cardiac computed tomography
  • echocardiography
  • heart failure
  • right ventricle
  • ventricular assist device

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Evaluation of right ventricular function and post-operative findings using cardiac computed tomography in patients with left ventricular assist devices. / Garcia-Alvarez, Ana; Fernandez-Friera, Leticia; Lau, Joe F.; Sawit, Simonette T.; Mirelis, Jesus G.; Castillo, Javier G.; Pinney, Sean; Anyanwu, Anelechi C.; Fuster, Valentin; Sanz, Javier; Garcia, Mario J.

In: Journal of Heart and Lung Transplantation, Vol. 30, No. 8, 08.2011, p. 896-903.

Research output: Contribution to journalArticle

Garcia-Alvarez, A, Fernandez-Friera, L, Lau, JF, Sawit, ST, Mirelis, JG, Castillo, JG, Pinney, S, Anyanwu, AC, Fuster, V, Sanz, J & Garcia, MJ 2011, 'Evaluation of right ventricular function and post-operative findings using cardiac computed tomography in patients with left ventricular assist devices', Journal of Heart and Lung Transplantation, vol. 30, no. 8, pp. 896-903. https://doi.org/10.1016/j.healun.2011.03.009
Garcia-Alvarez, Ana ; Fernandez-Friera, Leticia ; Lau, Joe F. ; Sawit, Simonette T. ; Mirelis, Jesus G. ; Castillo, Javier G. ; Pinney, Sean ; Anyanwu, Anelechi C. ; Fuster, Valentin ; Sanz, Javier ; Garcia, Mario J. / Evaluation of right ventricular function and post-operative findings using cardiac computed tomography in patients with left ventricular assist devices. In: Journal of Heart and Lung Transplantation. 2011 ; Vol. 30, No. 8. pp. 896-903.
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abstract = "Background: Right ventricular (RV) failure is a major contributor to morbidity and mortality after left ventricular assist device (LVAD) implantation. Accurate evaluation of RV function in patients with LVAD remains challenging. We hypothesized that, after LVAD implantation, electrocardiographic-gated cardiac computed tomography (CCT) allows RV evaluation with higher feasibility and reproducibility compared with echocardiography. Methods: Thirty-six patients with an implanted LVAD who had 2-dimensional echocardiography and CCT evaluation were studied. RV end-diastolic and end-systolic volumes and ejection fraction were quantified using CCT. RV fractional area change, tricuspid annular plane systolic excursion and RV end-diastolic short-to-long axis ratio were calculated by echocardiography. Intraclass correlation coefficients (ICCs) and BlandAltman analysis were used to assess intra- and interobserver reproducibility for all measurements. Results: The quality of CCT studies was good in all cases except for one. Intra- and interobserver reproducibility for all CCT measurements was high (interobserver ICC for RV ejection fraction = 0.89, 95{\%} confidence interval 0.74 to 0.95). Echocardiographic indices of RV function and geometry had lower reproducibility. The echocardiographic index that best correlated with the CCT-determined RV ejection fraction was RV fractional area change (r = 0.80, p < 0.001). In addition, CCT detected relevant post-operative findings in 50{\%} of the patients. Conclusions: CCT is highly effective and reproducible compared with echocardiography for the evaluation of RV function in patients with LVAD support and provides relevant information on post-operative findings. Our results suggest that CCT should be considered as a useful imaging modality in this clinical setting.",
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AU - Garcia-Alvarez, Ana

AU - Fernandez-Friera, Leticia

AU - Lau, Joe F.

AU - Sawit, Simonette T.

AU - Mirelis, Jesus G.

AU - Castillo, Javier G.

AU - Pinney, Sean

AU - Anyanwu, Anelechi C.

AU - Fuster, Valentin

AU - Sanz, Javier

AU - Garcia, Mario J.

PY - 2011/8

Y1 - 2011/8

N2 - Background: Right ventricular (RV) failure is a major contributor to morbidity and mortality after left ventricular assist device (LVAD) implantation. Accurate evaluation of RV function in patients with LVAD remains challenging. We hypothesized that, after LVAD implantation, electrocardiographic-gated cardiac computed tomography (CCT) allows RV evaluation with higher feasibility and reproducibility compared with echocardiography. Methods: Thirty-six patients with an implanted LVAD who had 2-dimensional echocardiography and CCT evaluation were studied. RV end-diastolic and end-systolic volumes and ejection fraction were quantified using CCT. RV fractional area change, tricuspid annular plane systolic excursion and RV end-diastolic short-to-long axis ratio were calculated by echocardiography. Intraclass correlation coefficients (ICCs) and BlandAltman analysis were used to assess intra- and interobserver reproducibility for all measurements. Results: The quality of CCT studies was good in all cases except for one. Intra- and interobserver reproducibility for all CCT measurements was high (interobserver ICC for RV ejection fraction = 0.89, 95% confidence interval 0.74 to 0.95). Echocardiographic indices of RV function and geometry had lower reproducibility. The echocardiographic index that best correlated with the CCT-determined RV ejection fraction was RV fractional area change (r = 0.80, p < 0.001). In addition, CCT detected relevant post-operative findings in 50% of the patients. Conclusions: CCT is highly effective and reproducible compared with echocardiography for the evaluation of RV function in patients with LVAD support and provides relevant information on post-operative findings. Our results suggest that CCT should be considered as a useful imaging modality in this clinical setting.

AB - Background: Right ventricular (RV) failure is a major contributor to morbidity and mortality after left ventricular assist device (LVAD) implantation. Accurate evaluation of RV function in patients with LVAD remains challenging. We hypothesized that, after LVAD implantation, electrocardiographic-gated cardiac computed tomography (CCT) allows RV evaluation with higher feasibility and reproducibility compared with echocardiography. Methods: Thirty-six patients with an implanted LVAD who had 2-dimensional echocardiography and CCT evaluation were studied. RV end-diastolic and end-systolic volumes and ejection fraction were quantified using CCT. RV fractional area change, tricuspid annular plane systolic excursion and RV end-diastolic short-to-long axis ratio were calculated by echocardiography. Intraclass correlation coefficients (ICCs) and BlandAltman analysis were used to assess intra- and interobserver reproducibility for all measurements. Results: The quality of CCT studies was good in all cases except for one. Intra- and interobserver reproducibility for all CCT measurements was high (interobserver ICC for RV ejection fraction = 0.89, 95% confidence interval 0.74 to 0.95). Echocardiographic indices of RV function and geometry had lower reproducibility. The echocardiographic index that best correlated with the CCT-determined RV ejection fraction was RV fractional area change (r = 0.80, p < 0.001). In addition, CCT detected relevant post-operative findings in 50% of the patients. Conclusions: CCT is highly effective and reproducible compared with echocardiography for the evaluation of RV function in patients with LVAD support and provides relevant information on post-operative findings. Our results suggest that CCT should be considered as a useful imaging modality in this clinical setting.

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KW - echocardiography

KW - heart failure

KW - right ventricle

KW - ventricular assist device

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