title: Speckle tracking echocardiography as a new technique to evaluate right ventricular function in patients with left ventricular assist device therapy.
abstract: BACKGROUND
  Right ventricular (RV) systolic function has a critical role in determining the clinical outcome and the success of using left ventricular assist devices (LVADs) in patients with refractory heart failure. RV deformation analysis by speckle tracking echocardiography (STE) has recently allowed a deeper analysis of RV longitudinal function. The aim of the study was to observe RV function by STE in patients with advanced heart failure before and after LVAD implantation.
  
  
  METHODS
  Transthoracic echo Doppler was performed in 10 patients referred for LVAD therapy at baseline and with serial echocardiograms after LVAD implantation. In a sub-group of 4 patients, an echocardiographic evaluation was also made after intra-aortic balloon pump (IABP) support was initiated and before LVAD implantation. All echocardiographic images were analyzed off-line to calculate the free wall RV longitudinal strain (RVLS).
  
  
  RESULTS
  Three patients who presented the lowest free wall RVLS values at baseline, showed a progressive decline of RVLS after LVAD implant, presenting finally RV failure; however, patients with higher values of RVLS at baseline presented a further and overt increase of strain values in the course of follow-up. The overall performance for the prediction of RV failure after LVAD implant was greatest for free wall RVLS (area under the curve, 0.93). For the sub-group receiving the IABP as an intermediate step, only 2 patients with an increase of RVLS after IABP implantation also showed an increase of RVLS levels, after subsequent LVAD implantation. The 2 patients without an increase of RVLS after IABP implantation also presented with RV failure after LVAD therapy.
  
  
  CONCLUSIONS
  This study of 10 patients indicates that the new parameter of RVLS, representing RV myocardial deformation, may have important clinical implications for the selection and management of LVAD patients. A large multicenter study is required to confirm these observations and to quantify the clinical significance of changes in RVLS value.
authors.affiliation: Department of Cardiovascular Diseases, University of Siena, Italy. cameli@cheapnet.it
authors.forename: Matteo
authors.initials: M
authors.lastname: Cameli
authors.forename: Matteo
authors.initials: M
authors.lastname: Lisi
authors.forename: Francesca Maria
authors.initials: FM
authors.lastname: Righini
authors.forename: Marta
authors.initials: M
authors.lastname: Focardi
authors.forename: Stefano
authors.initials: S
authors.lastname: Lunghetti
authors.forename: Sonia
authors.initials: S
authors.lastname: Bernazzali
authors.forename: Luca
authors.initials: L
authors.lastname: Marchetti
authors.forename: Bonizella
authors.initials: B
authors.lastname: Biagioli
authors.forename: Maurizio
authors.initials: M
authors.lastname: Galderisi
authors.forename: Massimo
authors.initials: M
authors.lastname: Maccherini
authors.forename: Guido
authors.initials: G
authors.lastname: Sani
authors.forename: Sergio
authors.initials: S
authors.lastname: Mondillo
mesh_terms: D000368:Aged; D004452:Echocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D016278:Ventricular Function, Right