Serial echocardiography using tissue doppler and speckle tracking imaging to monitor right ventricular failure before and after left ventricular assist device surgery

Tomoko Sugiyama Kato, Jeffrey Jiang, Paul Christian Schulze, Ulrich P. Jorde, Nir Uriel, Shuichi Kitada, Hiroo Takayama, Yoshifumi Naka, Donna Mancini, Linda Gillam, Shunichi Homma, Maryjane Farr

Research output: Contribution to journalArticle

50 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)216-222
Number of pages7
JournalJACC: Heart Failure
Volume1
Issue number3
DOIs
StatePublished - Jun 2013
Externally publishedYes

Fingerprint

Heart-Assist Devices
Echocardiography
Ambulatory Surgical Procedures
Vasodilator Agents
Lung
Therapeutics
Population

Keywords

  • Echocardiogram
  • Heart failure
  • Left ventricular assist device
  • Prediction
  • Right ventricular failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Serial echocardiography using tissue doppler and speckle tracking imaging to monitor right ventricular failure before and after left ventricular assist device surgery. / Kato, Tomoko Sugiyama; Jiang, Jeffrey; Schulze, Paul Christian; Jorde, Ulrich P.; Uriel, Nir; Kitada, Shuichi; Takayama, Hiroo; Naka, Yoshifumi; Mancini, Donna; Gillam, Linda; Homma, Shunichi; Farr, Maryjane.

In: JACC: Heart Failure, Vol. 1, No. 3, 06.2013, p. 216-222.

Research output: Contribution to journalArticle

Kato, Tomoko Sugiyama ; Jiang, Jeffrey ; Schulze, Paul Christian ; Jorde, Ulrich P. ; Uriel, Nir ; Kitada, Shuichi ; Takayama, Hiroo ; Naka, Yoshifumi ; Mancini, Donna ; Gillam, Linda ; Homma, Shunichi ; Farr, Maryjane. / Serial echocardiography using tissue doppler and speckle tracking imaging to monitor right ventricular failure before and after left ventricular assist device surgery. In: JACC: Heart Failure. 2013 ; Vol. 1, No. 3. pp. 216-222.
@article{ae9f6ea289d243cd9ef5fb1ce413153f,
title = "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.",
keywords = "Echocardiogram, Heart failure, Left ventricular assist device, Prediction, Right ventricular failure",
author = "Kato, {Tomoko Sugiyama} and Jeffrey Jiang and Schulze, {Paul Christian} and Jorde, {Ulrich P.} and Nir Uriel and Shuichi Kitada and Hiroo Takayama and Yoshifumi Naka and Donna Mancini and Linda Gillam and Shunichi Homma and Maryjane Farr",
year = "2013",
month = "6",
doi = "10.1016/j.jchf.2013.02.005",
language = "English (US)",
volume = "1",
pages = "216--222",
journal = "JACC: Heart Failure",
issn = "2213-1779",
publisher = "Elsevier BV",
number = "3",

}

TY - JOUR

T1 - Serial echocardiography using tissue doppler and speckle tracking imaging to monitor right ventricular failure before and after left ventricular assist device surgery

AU - Kato, Tomoko Sugiyama

AU - Jiang, Jeffrey

AU - Schulze, Paul Christian

AU - Jorde, Ulrich P.

AU - Uriel, Nir

AU - Kitada, Shuichi

AU - Takayama, Hiroo

AU - Naka, Yoshifumi

AU - Mancini, Donna

AU - Gillam, Linda

AU - Homma, Shunichi

AU - Farr, Maryjane

PY - 2013/6

Y1 - 2013/6

N2 - 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.

AB - 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.

KW - Echocardiogram

KW - Heart failure

KW - Left ventricular assist device

KW - Prediction

KW - Right ventricular failure

UR - http://www.scopus.com/inward/record.url?scp=84878647282&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84878647282&partnerID=8YFLogxK

U2 - 10.1016/j.jchf.2013.02.005

DO - 10.1016/j.jchf.2013.02.005

M3 - Article

VL - 1

SP - 216

EP - 222

JO - JACC: Heart Failure

JF - JACC: Heart Failure

SN - 2213-1779

IS - 3

ER -