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- Title
Evaluation of right ventricular function using liver stiffness in patients with left ventricular assist device.
- Authors
Noriyuki Kashiyama; Koichi Toda; Teruya Nakamura; Shigeru Miyagawa; Hiroyuki Nishi; Yasushi Yoshikawa; Satsuki Fukushima; Shunsuke Saito; Daisuke Yoshioka; Yoshiki Sawa
- Abstract
OBJECTIVES: Although right ventricular failure (RVF) is a major concern after left ventricular assist device (LVAD) implantation, methodologies to evaluate RV function remain limited. Liver stiffness (LS), which is closely related to right-sided filling pressure and may indicate RVF severity, could be non-invasively and repeatedly assessed using transient elastography. Here we investigated the suitability of LS as a parameter of RV function in pre- and post-LVAD periods. METHODS: The study included 55 patients with LVAD implantation as a bridge to transplantation between 2011 and 2015 whose LS was assessed using transient elastography. RESULTS: Seventeen patients presented with RVF, defined as requiring inotropic support for >30 days, nitric oxygen inhalation for >5 days, and/or mechanical RV support following LVAD implantation. Survival of patients with RVF was significantly worse compared with that of patients without RVF. Multivariate logistic regression analysis identified preoperative LS, LV diastolic dimension, RV stroke work index, and dilated phase of hypertrophic cardiomyopathy aetiology as significant risk factors; the combination of these parameters could improve predictive power of post-LVAD RVF with areas under the curve of 0.89. Furthermore, LS was significantly decreased by LV unloading and significantly correlated with right-sided filling pressure. CONCLUSIONS: In addition to dilated hypertrophic cardiomyopathy aetiology, reduced RV stroke work index and small LV dimension, we demonstrated that non-invasively measured LS was a predictor of post-LVAD RVF and can be used as a parameter for the evaluation and optimization of RV function in the perioperative period.
- Subjects
HEART assist devices; VENTRICULAR outflow obstruction; CARDIAC arrest; IMPLANTABLE catheters; ARTIFICIAL implants
- Publication
European Journal of Cardio-Thoracic Surgery, 2017, Vol 51, Issue 4, p715
- ISSN
1010-7940
- Publication type
Article
- DOI
10.1093/ejcts/ezw419