RESUMEN
OBJECTIVES: Right heart failure (RHF) is an important prognostic factor in continuous-flow left ventricular assist device (LVAD) therapy. We aimed to assess the clinical variables associated with RHF after LVAD implantation and to compare their performance against currently available RHF predictive scoring systems. METHODS: The study cohort comprised 57 patients who underwent LVAD therapy between January 2012 and May 2018 in our centre. The mean age of the patients was 39.9 ± 18.3 years, and 43 (81.1%) of them were men. Thirty-eight patients (66.6%) were in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile I or II. The study cohort was divided into the patients with RHF postoperatively (n = 20, 35.1%) and without RHF (n = 37, 64.9%). RESULTS: Independent predictors for RHF were preoperative right ventricular ejection fraction <25% [odds ratio (OR) 4.68, 95% confidence interval (CI) 1.41-15.5; P = 0.01], right ventricular stroke work index <400 mmHg ml-1 (OR 3.73, 95% CI 1.01-13.7; P = 0.04), right ventricular outflow tract systolic excursion <7 mm (OR 1.55, 95% CI 0.31-0.84; P = 0.002), right ventricular outflow tract fractional shortening <15% (OR 1.62, 95% CI 0.34-0.78; P = 0.02), right ventricular free wall longitudinal strain ≤19% (OR 3.13, 95% CI 1.01-2.43; P = 0.003), right ventricular fractional area change <27% (OR 3.71, 95% CI 1.15-11.9; P = 0.02) and prealbumin <14 mg/dl (OR 3.45, 95% CI 1.07-11.03; P = 0.03). Modest diagnostic performance for RHF was detected in 4 of 7 validated scoring systems with resulting area under the curve values of 0.70 (95% CI 0.55-0.84; P = 0.001) for the Seattle Heart Failure Model; 0.68 (95% CI 0.49-0.81, P = 0.03) for the Fitzpatrick's; 0.68 (95% CI 0.53-0.83, P = 0.028) for the acute physiology and chronic health evaluation (APACHE) II; and 0.66 (95% CI 0.50-0.82, P = 0.04) for the model for end-stage liver disease scoring systems. However, we found best discrimination performance of the score with a resulting area under the curve value of 0.94 (95% CI 0.55-0.89, P = 0.03) for right ventricular free wall longitudinal strain ≥-15.5% and 0.82 for right ventricular stroke work index <400 mmHg ml-1 m-2 in predicting RHF. CONCLUSIONS: Right ventricular free wall longitudinal strain ≥-15.5% and right ventricular stroke work index <400 mmHg ml-1 m-2 were independent predictors of RHF following LVAD implantation. Currently available prediction risk scores had the modest power of accuracy in the low INTERMACS profile Turkish population.
Asunto(s)
Insuficiencia Cardíaca/terapia , Ventrículos Cardíacos/fisiopatología , Corazón Auxiliar , Volumen Sistólico/fisiología , Función Ventricular Derecha/fisiología , Adolescente , Adulto , Anciano , Niño , Ecocardiografía , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND: Nondipping blood pressure pattern carry a high risk of cardiovascular and cerebrovascular complications due to a higher cumulative pressure overload. We aimed to define the role of strain analysis for detecting subclinical left ventricular systolic dysfunction in recently diagnosed nondipper and dipper hypertensive patients with normal left ventricular systolic function. METHODS: Study population consisted of two groups of patients, Group 1: 45 dipper patients and Group 2: 43 nondipper patients. Global and segmental two-dimensional longitudinal strain analysis were measured by speckle tracking method. RESULTS: The analysis of two-dimensional left ventricular global longitudinal strain and strain rates showed that there was a significant difference between groups (-18.1%±3.1% for nondippers vs -20.5%±2.4% for dippers, P<.001 for global longitudinal strain and -1.2±0.2 1/s for nondippers vs -1.31±0.16 1/s for dippers, P<.001 for global longitudinal strain rate). The nighttime systolic, diastolic, and mean blood pressure measurements were significantly higher in the nondipper group. Nocturnal dipping rates were statistically different between the groups (P<.001). Interventricular septum, posterior wall thickness, relative wall thickness, left atrial dimension, left ventricular mass, and mass index were higher in the nondipper group. Multivariate analysis demonstrated left atrium size, nocturnal dipping rate, daytime mean blood pressure, and nighttime systolic, diastolic, and mean blood pressure as independent predictors of global longitudinal strain. CONCLUSION: In our study, two-dimensional speckle tracking examination showed that the left ventricular systolic function is impaired even in the subclinical period in recently diagnosed nondipper hypertensive patients with deformational analysis.