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 Jorde, Nir Uriel, Shuichi Kitada, Hiroo Takayama, Yoshifumi Naka, Donna Mancini, Linda Gillam, Shunichi Homma, Maryjane Farr

Research output: Contribution to journalArticle

62 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Serial echocardiography using tissue doppler and speckle tracking imaging to monitor right ventricular failure before and after left ventricular assist device surgery'. Together they form a unique fingerprint.

  • Cite this

    Kato, T. S., Jiang, J., Schulze, P. C., Jorde, U., Uriel, N., Kitada, S., Takayama, H., Naka, Y., Mancini, D., Gillam, L., Homma, S., & Farr, M. (2013). Serial echocardiography using tissue doppler and speckle tracking imaging to monitor right ventricular failure before and after left ventricular assist device surgery. JACC: Heart Failure, 1(3), 216-222. https://doi.org/10.1016/j.jchf.2013.02.005