Kirolos Barssoum1, Ahmed M Altibi2, Devesh Rai3, Adnan Kharsa3, Ashish Kumar4, Medhat Chowdhury3, Ahmed Elkaryoni5, Ahmed Sami Abuzaid6, Bipul Baibhav7, Vishal Parikh8, Ahmad Masri9, Myriam Amsallem10, Navin C Nanda11. 1. Department of Internal Medicine, Unity Hospital, Rochester Regional Health System, Rochester, NY, USA. 2. Department of Internal Medicine, Henry Ford Allegiance Health, Jackson, MI, USA. 3. Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA. 4. Department of Critical Care, St. John's Medical College, Bangalore, India. 5. Department of Cardiovascular Medicine, Loyola University Medical Center, Maywood, IL, USA. 6. Department of Cardiology, Alaska and Vascular Institute LLC, Anchorage, AL, USA. 7. Department of Cardiology, Sands Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA. 8. Department of Advanced Heart Failure and Transplant, Sands Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA. 9. Department of Cardiology, Oregon Health and Science University, Portland, Oregon, USA. 10. Department of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA. 11. Division of Cardiovascular Disease, University of Alabama, Birmingham, AL, USA.
Abstract
BACKGROUND: Right ventricular failure (RVF) following left ventricular assist device (LVAD) implantation is associated with worse outcomes. Prediction of RVF is difficult with routine transthoracic echocardiography (TTE), while speckle-tracking echocardiography (STE) showed promising results. We performed systematic review and meta-analysis of published literature. METHODS: We queried multiple databases to compile articles reporting preoperative or intraoperative right ventricle global longitudinal strain (RVGLS) or right ventricle free wall strain (RVFWS) in LVAD recipients. The standard mean difference (SMD) in RVGLS and RVFWS in patients with and without RVF postoperatively was pooled using random-effects model. RESULTS: Seventeen studies were included. Patients with RVF had significantly lower RVGLS and RVFWS as compared to non-RVF patients; SMD: 2.79 (95% CI: -4.07 to -1.50; P: <.001) and -3.05 (95% CI: -4.11 to -1.99; P: <.001), respectively. The pooled odds ratio (OR) for RVF per percentage increase of RVGLS and RVFWS were 1.10 (95 CI: 0.98-1.25) and 1.63 (95% CI 1.07-2.47), respectively. In a subgroup analysis, TTE-derived GLS and FWS were significantly lower in RVF patients as compared to non-RVF patients; SMD of -3.97 (95% CI: -5.40 to -2.54; P: <.001) and -3.05 (95% CI: -4.11 to -1.99; P: <.001), respectively. There was no significant difference between RVF and non-RVF groups in TEE-derived RVGLS and RVFWS. CONCLUSION: RVGLS and RVFWS were lower in patients who developed RVF as compared to non-RVF patients. In a subgroup analysis, TTE-derived RVGLS and RVFWS were reduced in RVF patients as compared to non-RVF patients. This difference was not reported with TEE.
BACKGROUND: Right ventricular failure (RVF) following left ventricular assist device (LVAD) implantation is associated with worse outcomes. Prediction of RVF is difficult with routine transthoracic echocardiography (TTE), while speckle-tracking echocardiography (STE) showed promising results. We performed systematic review and meta-analysis of published literature. METHODS: We queried multiple databases to compile articles reporting preoperative or intraoperative right ventricle global longitudinal strain (RVGLS) or right ventricle free wall strain (RVFWS) in LVAD recipients. The standard mean difference (SMD) in RVGLS and RVFWS in patients with and without RVF postoperatively was pooled using random-effects model. RESULTS: Seventeen studies were included. Patients with RVF had significantly lower RVGLS and RVFWS as compared to non-RVF patients; SMD: 2.79 (95% CI: -4.07 to -1.50; P: <.001) and -3.05 (95% CI: -4.11 to -1.99; P: <.001), respectively. The pooled odds ratio (OR) for RVF per percentage increase of RVGLS and RVFWS were 1.10 (95 CI: 0.98-1.25) and 1.63 (95% CI 1.07-2.47), respectively. In a subgroup analysis, TTE-derived GLS and FWS were significantly lower in RVF patients as compared to non-RVF patients; SMD of -3.97 (95% CI: -5.40 to -2.54; P: <.001) and -3.05 (95% CI: -4.11 to -1.99; P: <.001), respectively. There was no significant difference between RVF and non-RVF groups in TEE-derived RVGLS and RVFWS. CONCLUSION: RVGLS and RVFWS were lower in patients who developed RVF as compared to non-RVF patients. In a subgroup analysis, TTE-derived RVGLS and RVFWS were reduced in RVF patients as compared to non-RVF patients. This difference was not reported with TEE.
Authors: Kei Sato; Jonathan Chan; Vinesh Appadurai; Nchafatso Obonyo; Louise See Hoe; Jacky Y Suen; John F Fraser Journal: Crit Care Explor Date: 2022-03-30