title: Serial echocardiography using tissue Doppler and speckle tracking imaging to monitor right ventricular failure before and after left ventricular assist device surgery.
abstract: OBJECTIVE
  This study aimed to investigate the utility of serial tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) for monitoring right ventricular failure (RVF) after left ventricular assist device (LVAD) surgery.
  
  
  BACKGROUND
  RVF post-LVAD is a devastating adverse event.
  
  
  METHODS
  The authors prospectively studied 68 patients undergoing elective LVAD surgery. Echocardiograms were performed within 72 h before and 72 h after surgery. RVF was pre-specified as: 1) the need for salvage right ventricular assist device (RVAD); or 2) persistent need for inotrope and/or pulmonary vasodilator therapy 14 days after surgery. Patients were classified as Group RVF or Group Non-RVF.
  
  
  RESULTS
  A total of 24 patients (35.3%) met criteria for RVF. Preoperative TDI-derived S' was lower and RV E/E' ratio was higher (3.7 ± 0.6 cm/s vs. 4.7 ± 0.9 cm/s, 12.0 ± 2.3 vs. 10.0 ± 2.5, both p < 0.001, respectively), and the absolute value of RV longitudinal strain (RV-strain) obtained from STE was lower (-12.6 ± 3.3% vs. -16.2 ± 4.3%, p < 0.001) in Group RVF vs. Group Non-RVF. Echo parameters within 72 h after surgery showed higher RV-E/E', (13.9 ± 4.6 vs. 10.1 ± 3.0, p < 0.001) and lower RV-strain (-11.8 ± 3.5% vs. -16.7 ± 4.4%, p < 0.001) in Group RVF vs. Group Non-RVF. Preoperative S'<4.4 cm/s, RV-E/E'>10 and RV-strain < -14% discriminated patients who developed RVF at day 14 with a predictive accuracy of 76.5%. When we included postoperative RV-E/E' and RV-strain, the predictive accuracy increased to 80.9%, with a sensitivity of 66.7% and a specificity of 88.7%.
  
  
  CONCLUSIONS
  Serial echocardiograms using TDI and STE before and soon after LVAD surgery may aid in identifying need to initiate targeted RVF specific therapy in this population.
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Tomoko Sugiyama
authors.initials: TS
authors.lastname: Kato
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Jiang
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Paul Christian
authors.initials: PC
authors.lastname: Schulze
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Jorde
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Nir
authors.initials: N
authors.lastname: Uriel
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Kitada
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Donna
authors.initials: D
authors.lastname: Mancini
authors.affiliation: Division of Cardiology, Morristown Memorial Hospital, Morristown, New Jersey.
authors.forename: Linda
authors.initials: L
authors.lastname: Gillam
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York. Electronic address: maf2171@columbia.edu.
authors.forename: Maryjane
authors.initials: M
authors.lastname: Farr
mesh_terms: D057791:Cardiac Imaging Techniques; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011300:Preoperative Care; D011446:Prospective Studies; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000000981:diagnostic imaging*
keywords: echocardiogram; heart failure; left ventricular assist device; prediction; right ventricular failure