右心室心肌应变与左心室辅助装置植入后早期右心衰竭的相关性研究

Relationship between right ventricular myocardial strain and early-stage right heart failure after left ventricular assist device implantation

目的:初步探讨右心室心肌应变对左心室辅助装置(LVAD)植入后患者发生急性右心衰竭(RHF)的影响。方法:连续性纳入2022年4月至2023年5月在西安交通大学第一附属医院进行LVAD植入的20例心力衰竭患者。所有患者在LVAD植入前均进行常规经胸超声心动图检查,详细评估左心室功能和右心室功能。根据患者LVAD植入后是否发生RHF分为无RHF组(15例)和RHF组(5例)。采用二维斑点追踪超声心动图技术获得右心室游离壁纵向应变(RVFWSL)、右心室整体纵向应变(RV4CSL)。采用多因素logistic回归分析探讨LVAD植入后RHF发生的影响因素。结果:RHF组和无RHF组患者左心室射血分数(LVEF)[(19±6)%vs.(27±4)%,t=2.674,P=0.040]、右心室收缩末容积(RVESV)[(60±26)mL vs.(28±18)mL,t=3.074,P=0.007]、右心室射血分数(RVEF)[(27±13)%vs.(50±12)%,t=3.635,P=0.002]、右心室面积变化分数(RVFAC)[(22±5)%vs.(34±7)%,t=3.776,P=0.002]、RVFWSL[(11.9±2.1)%vs.(23.0±6.9)%,t=3.446,P=0.003]和RV4CSL[(11.4±2.8)%vs.(20.8±6.8)%,t=2.944,P=0.009]比较,差异均有统计学意义。多因素logistic回归分析结果显示,RVEF[比值比(OR)=0.872,95%置信区间(CI)(0.773,0.984),P=0.041]、RVFAC[OR=0.779,95%CI(0.589,0.930),P=0.045]、RVFWSL[OR=0.530,95%CI(0.286,0.982),P=0.040]、RV4CSL[OR=0.667,95%CI(0.454,0.979),P=0.041]是LVAD植入后RHF的影响因素,提示右心室整体收缩功能越差,患者LVAD植入后发生RHF的可能性越大。结论:终末期心力衰竭患者传统右心室收缩功能参数RVEF、RVFAC及右心室应变参数RVFWSL、RV4CSL越低,LVAD植入后发生早期RHF的可能性越大。对于传统右心室整体收缩功能保留的患者,结合右心室应变参数将会在一定程度上提供更细微的右心室收缩功能参数,提高LVAD患者选择的准确性。

ObjectiveTo preliminarily investigate the effect of right ventricular myocardial strain on the occurrence of acute right heart failure (RHF) in patients after left ventricular assist device (LVAD) implantation.MethodsA total of 20 patients with heart failure who underwent LVAD implantation from April 2022 to May 2023 at the First Affiliated Hospital of Xi'an Jiaotong University were consecutively included. All patients underwent routine transthoracic echocardiography before LVAD implantation. Parameters of left heart function and right heart function were obtained. Patients were divided into a no-RHF group (15 patients) and a RHF group (5 patients) according to whether RHF occurred after LVAD implantation. Right ventricular free wall longitudinal strain (RVFWSL) and right ventricle four-chamber longitudinal strain (RV4CSL) were obtained using two-dimensional speckle tracking echocardiography. Multifactorial logistic regression analysis was used to explore the factors affecting RHF after LVAD implantation.ResultsThe left ventricular ejection fraction (LVEF) [(19 ± 6)% vs. (27 ± 4)%, t = 2.674, P = 0.040], right ventricular end-systolic volume (RVESV) [(60 ± 26) mL vs. (28 ± 18) mL, t = 3.074, P = 0.007], right ventricular ejection fraction (RVEF) [(27 ± 13)% vs. (50 ± 12)%, t = 3.635, P = 0.002], right ventricular fractional area change (RVFAC) [(22 ± 5)% vs. (34 ± 7)%, t = 3.776, P = 0.002], RVFWSL [(11.9 ± 2.1)% vs. (23.0 ± 6.9)%, t = 3.446, P = 0.003] and RV4CSL [(11.4 ± 2.8)% vs. (20.8 ± 6.8)%, t = 2.944, P = 0.009] in the RHF and no-RHF groups showed statistically significant differences. Multifactorial logistic regression analysis showed that the RVEF [odds ratio (OR) = 0.872, 95% confidence interval (CI) (0.773, 0.984), P = 0.041], RVFAC [OR = 0.779, 95%CI (0.589, 0.930), P = 0.045], RVFWSL [OR = 0.530, 95%CI (0.286, 0.982), P = 0.040] and RV4CSL [OR = 0.667, 95%CI (0.454, 0.979), P = 0.041] were the factors influencing RHF after LVAD implantation. It is suggested that the worse the overall right ventricular systolic function is, the more likely the patient is to develop RHF after LVAD implantation.ConclusionsThe lower the traditional right ventricular systolic function parameters of RVEF and RVFAC and the right ventricular strain parameters of RVFWSL and RV4CSL, the greater the likelihood of early RHF after LVAD implantation in patients with end-stage heart failure. For patients with preserved overall right ventricular systolic function, the combination of right ventricular strain parameters will provide to some extent finer-grained right ventricular systolic function parameters and improve the accuracy of LVAD selection.