Echocardiographic Predictors of Adverse Outcomes After Continuous Left Ventricular Assist Device Implantation

被引:97
作者
Topilsky, Yan [2 ]
Oh, Jae K. [2 ]
Shah, Dipesh K.
Boilson, Barry A. [2 ]
Schirger, John A. [2 ]
Kushwaha, Sudhir S. [2 ]
Pereira, Naveen L. [2 ]
Park, Soon J. [1 ]
机构
[1] Mayo Clin, St Marys Hosp, Div Cardiovasc Surg, Rochester, MN 55902 USA
[2] Mayo Clin, Div Cardiovasc Dis, Rochester, MN 55902 USA
关键词
echocardiography; left ventricular assist device; POST-REMATCH ERA; DESTINATION THERAPY; PATIENT SELECTION; SCREENING SCALE; HEART-FAILURE; RECOMMENDATIONS; REGURGITATION; INDEX;
D O I
10.1016/j.jcmg.2010.10.012
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES The purpose of the study was to identify echocardiographic predictors of adverse outcome in patients implanted with continuous-flow left ventricular assist devices (LVAD). BACKGROUND Continuous flow LVAD have become part of the standard of care for the treatment of advanced heart failure. However, knowledge of echocardiographic predictors of outcome after LVAD are lacking. METHODS Overall, 83 patients received continuous-flow LVAD (HeartMate II, Thoratec Corporation, Pleasanton, California) from February 2007 to June 2010. The LVAD database, containing various echocardiographic parameters, was examined to analyze their influence on in-hospital mortality, a compound cardiac event (in-hospital mortality or acute right ventricular [RV] dysfunction), and long-term mortality. RESULTS Eight patients died before discharge (operative mortality 9.6%), and another 15 patients were considered to have acute RV dysfunction immediately after surgery. Patients with relatively small left ventricular end-diastolic diameters (<63 mm) had significantly higher risk for in-hospital mortality (odds ratio [OR]: 0.9; 95% confidence interval [CI]: 0.83 to 0.99; p = 0.04) or occurrence of the compound cardiac event (OR: 0.89; 95% CI: 0.84 to 0.95; p < 0.001). The most significant predictor of outcome was the decreased timing interval between the onset and the cessation of tricuspid regurgitation flow corrected for heart rate (TRDc), a surrogate for early systolic equalization of RV and right atrial pressure. Short TRDc predicted in-hospital mortality (OR: 0.85; 95% CI: 0.74 to 0.97; p = 0.01) and the compound cardiac event (OR: 0.83; 95% CI: 0.74 to 0.91; p < 0.0001). Multivariate analysis based on a logistic regression model demonstrated that the accuracy of predicting the 30-day compound adverse outcome was improved with the addition of echocardiographic variables when added to the commonly used hemodynamic or clinical scores. TRDc predicted long-term survival, with adjusted risk ratios of 0.89 for death from any cause (95% CI: 0.83 to 0.96; p = 0.003) and 0.88 for cardiac-related death (95% CI: 0.77 to 0.98; p = 0.03). CONCLUSIONS The presence of either a relatively small left ventricle (<63 mm) or early systolic equalization of RV and right atrial pressure (short TRDc) demonstrated by echocardiography is associated with increased 30-day morbidity and mortality. Prediction of early adverse outcomes by echocardiographic parameters is additive to laboratory or hemodynamic variables. (J Am Coll Cardiol Img 2011;4:211-22) (C) 2011 by the American College of Cardiology Foundation
引用
收藏
页码:211 / 222
页数:12
相关论文
共 21 条
[1]   The evaluation of pulmonary hypertension using right ventricular myocardial isovolumic relaxation time [J].
Dambrauskaite, V ;
Delcroix, M ;
Claus, P ;
Herbots, L ;
Palecek, T ;
D'hooge, J ;
Bijnens, B ;
Rademakers, F ;
Sutherland, GR .
JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY, 2005, 18 (11) :1113-1120
[2]   Quantitative determinants of the outcome of asymptomatic mitral regurgitation [J].
Enriquez-Sarano, M ;
Avierinos, JF ;
Messika-Zeitoun, D ;
Detaint, D ;
Capps, M ;
Nkomo, V ;
Scott, C ;
Schaff, HV ;
Tajik, AJ .
NEW ENGLAND JOURNAL OF MEDICINE, 2005, 352 (09) :875-883
[3]   The systolic to diastolic duration ratio in children with hypoplastic left heart syndrome: A novel doppler index of right ventricular function [J].
Friedberg, Mark K. ;
Silverman, Norman H. .
JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY, 2007, 20 (06) :749-755
[4]  
Hammarstrom E, 1991, J Am Soc Echocardiogr, V4, P131
[5]   NONINVASIVE ESTIMATION OF RIGHT ATRIAL PRESSURE FROM THE INSPIRATORY COLLAPSE OF THE INFERIOR VENA-CAVA [J].
KIRCHER, BJ ;
HIMELMAN, RB ;
SCHILLER, NB .
AMERICAN JOURNAL OF CARDIOLOGY, 1990, 66 (04) :493-496
[6]   QT interval-heart rate relation during exercise in normal men and women: Definition by linear regression analysis [J].
Kligfield, P ;
Lax, KG ;
Okin, PM .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1996, 28 (06) :1547-1555
[7]   Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: Incidence, risk factors, and effect on outcomes [J].
Kormos, Robert L. ;
Teuteberg, Jeffrey J. ;
Pagani, Francis D. ;
Russell, Stuart D. ;
John, Ranjit ;
Miller, Leslie W. ;
Massey, Todd ;
Milano, Carmelo A. ;
Moazami, Nader ;
Sundareswaran, Kartik S. ;
Farrar, David J. .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2010, 139 (05) :1316-1324
[8]   Recommendations for chamber quantification: A report from the American Society of Echocardiography's guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology [J].
Lang, RM ;
Bierig, M ;
Devereux, RB ;
Flachskampf, FA ;
Foster, E ;
Pellikka, PA ;
Picard, MH ;
Roman, MJ ;
Seward, J ;
Shanewise, JS ;
Solomon, SD ;
Spencer, KT ;
Sutton, MS ;
Stewart, WJ .
JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY, 2005, 18 (12) :1440-1463
[9]   Outcomes of left ventricular assist device implantation as destination therapy in the post-REMATCH era - Implications for patient selection [J].
Lietz, Katherine ;
Long, James W. ;
Kfoury, Abdallah G. ;
Slaughter, Mark S. ;
Silver, Marc A. ;
Milano, Carmelo A. ;
Rogers, Joseph G. ;
Naka, Yoshifumi ;
Mancini, Donna ;
Miller, Leslie W. .
CIRCULATION, 2007, 116 (05) :497-505
[10]   Patient selection for left-ventricular assist devices [J].
Lietz, Katherine ;
Miller, Leslie W. .
CURRENT OPINION IN CARDIOLOGY, 2009, 24 (03) :246-251