title: Two-dimensional strain rate and Doppler tissue myocardial velocities: analysis by echocardiography of hemodynamic and functional changes of the failed left ventricle during different degrees of extracorporeal life support.
abstract: BACKGROUND
  To evaluate hemodynamic and functional changes of the failed left ventricle by Velocity Vector Imaging (VVI) and tissue Doppler, 22 patients with cardiogenic shock supported by extracorporeal life support (ECLS) were imaged during ECLS output variations inducing severe load manipulations.
  
  
  METHODS
  The following data were acquired: (1) mean arterial pressure, aortic Doppler velocity-time integral, left ventricular end-diastolic volume, and mitral Doppler E wave; (2) tissue Doppler systolic (Sa) and early diastolic (Ea) velocities; and (3) systolic peak velocity (Sv), strain, and strain rate using VVI.
  
  
  RESULTS
  Load variations were documented by a significant decrease in afterload (mean arterial pressure, -21%), an increase in preload (left ventricular end-diastolic volume, +12%; E, +46%; E/Ea ratio, +22%), and an increase in the velocity-time integral (+45%). VVI parameters increased (Sv, +36%; strain, +81%; and strain rate, +67%; P < .05), unlike tissue Doppler systolic velocities (+2%; P = NS). Whatever the ECLS flow, Sa was higher in patients who survived.
  
  
  CONCLUSIONS
  VVI parameters are not useful in characterizing the failed left ventricle with rapidly varying load conditions. Tissue Doppler systolic velocities appear to be load independent and thus could help in the management of ECLS patients.
authors.affiliation: Université René Descartes Paris V, Paris, France. nadia.aissaoui@sat.aphp.fr
authors.forename: Nadia
authors.initials: N
authors.lastname: Aissaoui
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Guerot
authors.forename: Alain
authors.initials: A
authors.lastname: Combes
authors.forename: Annie
authors.initials: A
authors.lastname: Delouche
authors.forename: Jean
authors.initials: J
authors.lastname: Chastre
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.forename: Philippe
authors.initials: P
authors.lastname: Leger
authors.forename: Jean Luc
authors.initials: JL
authors.lastname: Diehl
authors.forename: Jean Yves
authors.initials: JY
authors.lastname: Fagon
authors.forename: Benoit
authors.initials: B
authors.lastname: Diebold
mesh_terms: D000328:Adult; D000368:Aged; D004452:Echocardiography / Q000379:methods; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods; D005112:Extracorporeal Circulation; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009038:Motion; D012770:Shock, Cardiogenic / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000534:rehabilitation*; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000534:rehabilitation*; D055815:Young Adult