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Review
. 2014 Mar;7(2):379-89.
doi: 10.1161/CIRCIMAGING.113.001127.

Assessment of right ventricular function in left ventricular assist device candidates

Salim Hayek  1 , Daniel B Sims, David W Markham, Javed Butler, Andreas P Kalogeropoulos
Affiliations
Review

Assessment of right ventricular function in left ventricular assist device candidates

Salim Hayek et al. Circ Cardiovasc Imaging. 2014 Mar.
No abstract available

Keywords: decision support techniques; echocardiography; heart failure; heart-assist devices; right ventricle; ventricular-assist device.

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Figures

Figure 1
Figure 1
Right ventricular fractional area change (RVFAC) estimation in (A) a 73-year old male with ischemic cardiomyopathy who has become inotrope dependent in the past few months and (B) a 43-year old female with nonischemic cardiomyopathy awaiting heart transplantation who required an intra-aortic balloon pump for stabilization. Both patients received a Heart Mate II device 10 days later as destination therapy and bridge-to-transplant, respectively. Patient A was weaned from inotropes on postoperative day 5, whereas patient B required inotropic support for 38 days. Note the heavy trabeculation and the strong echo from the defibrillator lead in B.
Figure 2
Figure 2
Tricuspid annular systolic plane excursion (TAPSE) in the same patients as in Figure 1. Patient A exhibits a very low TAPSE (0.7 cm), indicative of severe RV dysfunction, despite the mildly abnormal RVFAC. In contrast, patient B has a low-normal TAPSE (1.6 cm) despite severely depressed RVFAC. However, as evident from the elevated heart rate (105 bpm), patient B is in hemodynamic stress, which is accompanied by exaggerated translational motion of the heart, thus overestimating TAPSE. The use of color M-mode, although not necessary for TAPSE estimation, facilitates detection of directional changes in motion.
Figure 3
Figure 3
Tricuspid annular systolic velocity (S’) by tissue Doppler imaging in the same patients as in Figure 1. Similar to tricuspid annular systolic plane excursion (TAPSE), longitudinal velocities are depended on load, translational motion, and insonation angle. Patient A exhibits abnormal S’ (<10 cm/s), whereas patient B has a low-normal S’ (11 cm/s), despite discordant RVFAC results.
Figure 4
Figure 4
Right ventricular (RV) longitudinal strain by speckle tracking in the same patients as in Figure 1. In patient A (ischemic etiology), the interventricular septum demonstrates very low peak strain (normal values: −14±4% to −22±5% from base to apex) suggestive of severe systolic dysfunction, whereas the RV free wall demonstrates preserved systolic function, especially at the basal and mid segments (lower reference values: −18% to −20%)., In patient B (nonischemic etiology), the very low peak strain values across all segments and the very low global strain (−4.3%) suggest severe global RV systolic dysfunction. Note also the fragmented systolic activation in the linearized map (lower left panel) in patient B as compared to the more homogenous activation in patient A.
See this image and copyright information in PMC

References

    1. Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Makuc DM, Marcus GM, Marelli A, Matchar DB, Moy CS, Mozaffarian D, Mussolino ME, Nichol G, Paynter NP, Soliman EZ, Sorlie PD, Sotoodehnia N, Turan TN, Virani SS, Wong ND, Woo D, Turner MB, American Heart Association Statistics C. Stroke Statistics S Heart disease and stroke statistics--2012 update: a report from the American Heart Association. Circulation. 2012;125:e2–e220. - PMC - PubMed
    1. Miller LW, Guglin M. Patient selection for ventricular assist devices: a moving target. J Am Coll Cardiol. 2013;61:1209–1221. - PubMed
    1. Kirklin JK, Naftel DC, Kormos RL, Stevenson LW, Pagani FD, Miller MA, Timothy Baldwin J, Young JB. Fifth INTERMACS annual report: risk factor analysis from more than 6,000 mechanical circulatory support patients. J Heart Lung Transplant. 2013;32:141–156. - PubMed
    1. Slaughter MS, Rogers JG, Milano CA, Russell SD, Conte JV, Feldman D, Sun B, Tatooles AJ, Delgado RM, 3rd, Long JW, Wozniak TC, Ghumman W, Farrar DJ, Frazier OH, HeartMate Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med. 2009;361:2241–2251. - PubMed
    1. Drakos SG, Janicki L, Horne BD, Kfoury AG, Reid BB, Clayson S, Horton K, Haddad F, Li DY, Renlund DG, Fisher PW. Risk factors predictive of right ventricular failure after left ventricular assist device implantation. Am J Cardiol. 2010;105:1030–1035. - PubMed

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