Echocardiography evaluation in extracorporeal support

2021 ◽  
pp. 599-612
Author(s):  
Susanna Price ◽  
Alessia Gambaro
Keyword(s):  
Supportive Therapy ◽  
Vital Role ◽  
Pathological Process ◽  
Left Ventricular ◽  
Successful Implementation ◽  
Extracorporeal Circuits ◽  
Echocardiographic Parameters ◽  
Ventricular Support ◽  
The Right ◽  
Extracorporeal Support

Extracorporeal circuits are increasingly used to support critically ill patients with severe cardiac and/or respiratory failure. They may be used as a bridge to recovery, transplantation, decision for further intervention, or as destination therapy. When undertaking echocardiography for extracorporeal support, certain key principles apply. First, as extracorporeal support is not a treatment per se, but rather a supportive therapy while awaiting resolution of the underlying pathological process echocardiography has a vital role in diagnosing/excluding any potentially treatable underlying cause for cardiorespiratory failure. Second, echocardiography is required to determine the requirement for right and/or left ventricular support, the level of support required, and assessing the ability of the right and left ventricles to support the extracorporeal circuit. This demands that the practitioner understands the different types of circuit, and the load that each will place on the heart. Third, echocardiography is mandatory to exclude cardiovascular contraindications to initiation of support. Echocardiography subsequently has a vital role in its successful implementation, including confirming/guiding correct cannula placement, ensuring the goals of support are met, detecting complications, and assessing tolerance to assistance. Finally, in patients requiring extracorporeal cardiac support, various echocardiographic parameters have been proposed to be used in conjunction with clinical and haemodynamic assessment in order to attempt to predict those patients who can be successfully weaned.

Echocardiography for advanced extracorporeal support

2015 ◽  
pp. 432-442
Author(s):  
Susanna Price ◽  
Jean-Luc Canivet
Keyword(s):  
Supportive Therapy ◽  
Vital Role ◽  
Pathological Process ◽  
Left Ventricular ◽  
Successful Implementation ◽  
Extracorporeal Circuits ◽  
Echocardiographic Parameters ◽  
Ventricular Support ◽  
The Right ◽  
Extracorporeal Support

Extracorporeal circuits are increasingly used to support critically ill patients with severe cardiac and/or respiratory failure. They may be used as a bridge to recovery, transplantation, decision for further intervention, or, in a very few patients with cardiac failure, as destination therapy. Although echocardiography for extracorporeal support is highly specialist, certain key principles apply. First, extracorporeal support is not a treatment per se, but rather a supportive therapy whilst awaiting resolution of the underlying pathological process. Thus echocardiography has a vital role in excluding any potentially treatable underlying cause for cardiorespiratory failure. Second, echocardiography is required to determine the requirement for right and/or left ventricular support, the level of support required, and assessing the ability of the right and left ventricles to support the extracorporeal circuit. This demands that the practitioner understands the different types of circuit, and the load that each will place on the heart. Third, echocardiography is mandatory to exclude cardiovascular contraindications to initiation of support. Echocardiography subsequently has a vital role in its successful implementation, including confirming/guiding correct cannula placement, ensuring the goals of support are met, detecting complications, and assessing tolerance to assistance. Finally, in patients requiring extracorporeal cardiac support, various echocardiographic parameters have been proposed to be used in conjunction with clinical and haemodynamic assessment in order to attempt to predict those patients who can be successfully weaned.

scholarly journals Hemodynamic Support Using Percutaneous Transfemoral Impella 5.0 and Impella RP for Refractory Cardiogenic Shock

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Pratik K. Dalal ◽  
Amy Mertens ◽  
Dinesh Shah ◽  
Ivan Hanson
Keyword(s):  
Left Ventricle ◽  
Pulmonary Artery ◽  
Cardiogenic Shock ◽  
Ventricular Function ◽  
Standard Of Care ◽  
Left Ventricular ◽  
Biventricular Failure ◽  
Ventricular Support ◽  
The Right ◽  
Flow Pump

Acute myocardial infarction (AMI) resulting in cardiogenic shock continues to be a substantial source of morbidity and mortality despite advances in recognition and treatment. Prior to the advent of percutaneous and more durable left ventricular support devices, prompt revascularization with the addition of vasopressors and inotropes were the standard of care in the management of this critical population. Recent published studies have shown that in addition to prompt revascularization, unloading of the left ventricle with the placement of the Impella percutaneous axillary flow pump can lead to improvement in mortality. Parameters such as the cardiac power output (CPO) and pulmonary artery pulsatility index (PAPi), obtained through pulmonary artery catheterization, can help ascertain the productivity of right and left ventricular function. Utilization of these parameters can provide the information necessary to escalate support to the right ventricle with the insertion of an Impella RP or the left ventricle with the insertion of larger devices, which provide more forward flow. Herein, we present a case of AMI complicated by cardiogenic shock resulting in biventricular failure treated with the percutaneous insertion of an Impella RP and Impella 5.0 utilizing invasive markers of left and right ventricular function to guide the management and escalation of care.

Systemic to Pulmonary Collaterals in Extremely Low Birth Weight Infants: Incidence, Clinical Significance, and Hemodynamic Features

2019 ◽  
Author(s):  
Cynthia Hayek ◽  
Rowena Cayabyab ◽  
Ima Thompson ◽  
Mahmood Ebrahimi ◽  
Bijan Siassi ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Clinical Outcomes ◽  
Left Ventricular ◽  
Extremely Low Birth Weight ◽  
Low Birth Weight Infants ◽  
Echocardiographic Parameters ◽  
Group 2 ◽  
The Right ◽  
Group 1

Abstract Objective To determine the incidence of systemic to pulmonary collaterals (SPCs) in extremely low birth weight infants and to assess its clinical and hemodynamic significance beyond the neonatal period. Study Design Retrospective cohort study was conducted on 61 infants with echocardiogram performed at the time of discharge to determine the presence of SPC and to measure the right and left ventricular outputs and left atrium to aortic ratio. We compared two groups: small or no SPC (Group 1) to moderate or large SPC (Group 2) on demographics, clinical outcomes, and echocardiographic parameters. Results Sixty-one infants were included. The incidence of SPC was 57%; 21% of infants had moderate or large shunts and 31% had small SPC. Demographics, clinical outcomes, and echocardiographic parameters were not significantly different between small or no SPC and moderate to large SPC. Conclusion More than half of the infants had SPC. The size of the shunt did not affect the clinical outcomes nor the echocardiographic parameters measured. All infants had cardiac output above the normative mean.

scholarly journals Evaluating Right Ventricular Function To Reveal Cancer Therapy Cardiotoxicity

2021 ◽  
Vol 10 (3) ◽  
Author(s):  
Alexey N. Sumin
Keyword(s):  
Cancer Therapy ◽  
Right Ventricle ◽  
Ventricular Function ◽  
Systolic Heart Failure ◽  
Relevant Information ◽  
Left Ventricular ◽  
Echocardiographic Parameters ◽  
Assessment Techniques ◽  
Chemotherapy Cardiotoxicity ◽  
The Right

Advances in cancer treatment resulted in augmented patient survival rate. However, anticancer therapy often causes heart damage in the form of a progressive systolic heart failure. Echocardiographic parameters of left ventricular function were conventionally used to detect early manifestations of cancer therapy cardiotoxicity. Improved diagnosing of the right ventricle condition revealed that it is negatively affected by chemotherapy as frequently as the left ventricle, and sometimes even earlier than the latter. Hence, currently, the right ventricle function and mechanics assessment techniques are actively developed for the chemotherapy cardiotoxicity diagnostic, primarily employing 3D echocardiography and speckle tracking analysis. The presented review provides relevant information on the matter and highlights insufficiently developed issues and fields of further research.

scholarly journals GENDER FEATURES OF STRUCTURAL-GEOMETRIC REMODELING OF THE LEFT VENTRICLE IN PATIENTS WITH MYOCARDIAL INFARCTION WITHOUT ELEVATION OF ST SEGMENT

2021 ◽  
pp. 51-55
Author(s):  
V. I. Maslovskyi
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricle ◽  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Concentric Hypertrophy ◽  
St Segment ◽  
Echocardiographic Parameters ◽  
The Right

Recently, there has been a tendency to increase the incidence of myocardial infarction without elevation of the ST segment, which, according to some data, accounts for about half of all registered MI. The main problem with this type of infarction is that the long-term prognosis in these patients remains unsatisfactory, and mortality one year after the catastrophe is equal to or even higher than mortality from ST-segment elevation myocardial infarction, which encourages continued predictors of unfavorable prognosis. Objective: to determine the gender characteristics of the structural and geometric remodeling of the left ventricle in patients with myocardial infarction without ST segment elevation. Materials and methods. We conducted a comprehensive study of 200 patients with acute myocardial infarction without ST-segment elevation (NSTEMI) aged 38 to 80 (mean 62.0 ± 0.71, median 62 and interquartile range 55 and 70). The structural and functional state of the myocardium and types of left ventricular remodeling according to transthoracic echocardiography were studied. Results. Analysis of the obtained data shows that echocardiographic parameters in patients with NSTEMI depending on gender did not reveal significant differences between different groups. The exception was the size of the right atrium, which was significantly higher in the group of men compared to women with comparable values of the size of the right ventricle and the ratio of the size of the left to the right atrium. Analysis of the nature of structural and geometric remodeling of the left ventricle in general by groups showed that almost half of the subjects registered concentric hypertrophy of the left ventricle. Concentric left ventricle remodeling was observed in one third of patients and in other patients - normal geometry and eccentric left ventricle hypertrophy. Thus, it was found that concentric models of left ventricle – concentric hypertrophy and concentric remodeling – were registered in the vast majority of patients with NSTEMI. The latter can be explained by a significant proportion of hypertension which was identified by us in most patients and, of course, contributed to the development of concentric models of left ventricle. Analysis of the nature of structural and geometric remodeling of the left ventricle depending on gender showed that in the group of men, compared with women, there was a significant increase in the incidence of concentric remodeling. At the same time, in women, compared with men, there was a significant increase in cases of more severe types of structural remodeling - concentric and eccentric hypertrophy. Thus, we found that gender differences in echocardiographic parameters in patients with NSTEMI relate exclusively to indicators of structural and geometric remodeling of the left ventricle. Signs of concentric and eccentric left ventricular hypertrophy predominate in women, and indicators of normal geometry and concentric left ventricular remodeling in men. This distribution of types of remodeling indicates a more severe course and unfavorable prognosis of NSTEMI in women.

scholarly journals Влияние длительности заболевания на развитие кардиальной патологии при анкилозирующем спондилите

2019 ◽  
pp. 21-23
Keyword(s):  
Ankylosing Spondylitis ◽  
Diastolic Dysfunction ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Diastolic Dysfunction ◽  
Echocardiographic Parameters ◽  
Group 2 ◽  
The Right ◽  
The Relationship ◽  
People Group

Ankylosing spondylitis (AS) is a disease characterized by a lesion not only of the musculoskeletal system, but also of the internal organs, including the heart. Objective: to identify the relationship between the duration of the disease and cardiac pathology in patients with AS. Material and methods: the study involved 85 patients with AS, which divided into two groups depending on the duration of the disease at the time of diagnosis and initiation of treatment. Group 1 – with duration of the disease less than 3 years (51 people). Group 2 – with duration of the disease more than 3 years (34 people). Indices of ASDAS-ESR, BASDAI, BASFI, echocardiographic parameters (left ventricular mass index, relative thickness of ventricular wall, E/a of mitral and tricuspid valves) and indicators of vectorcardiography (areas of loops P, QRS and T, MV-voltage, MV-azimuth, MV-rise) were calculated. The results showed that in patients with ankylosing spondylitis lasting up to 3 years there is a tendency to the development of left ventricular diastolic dysfunction and a decrease in the electrical activity of the left heart. With the increase in the duration of the disease, we found a tendency to the development of diastolic dysfunction of the right ventricle, also accompanied by an increase in the proportion of electrically inactive myocardium.

scholarly journals Echocardiographic parameters as predictors of three-months mortality in patients with 2019 Coronavirus infection

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
T Miranda Aquino ◽  
J M Pereira-Forcado ◽  
B Ordonez-Salazar ◽  
G Dominguez-Trejo ◽  
A Rangel-Guerra ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Longitudinal Strain ◽  
Clinical Laboratory ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Ventricular Dilation ◽  
Echocardiographic Parameters ◽  
The Right ◽  
Right Ventricular Dilation

Abstract Background Coronavirus disease 2019 is a systemic entity, where cardiac involvement has been described. The echocardiogram is a diagnostic tool that describes myocardial damage with good certainty. Objectives Determine which echocardiographic parameters are predictors of mortality. Analyze if there is a difference in clinical, laboratory and echocardiographic variables in terms of patients who died versus those who survived. Investigate the cut-off point of the echocardiographic parameters that is best associated with mortality. Methods Prospective, analytical, comparative study. Patients admitted to the hospital with Coronavirus 2019 infection. Clinical, laboratory and echocardiographic variables will be assessed. The association with three-month mortality of the different variables will be determined. We used ROC-curves for the best cut-off associated with mortality. The association with three-month mortality was analized using Cox regression, unadjusted analysis of the variables was performed, as well as adjusted analysis for age and gender. Results 84 patients were included, a mortality of 29% was documented. Significant differences were found in the left atrial volumen index, the E/e', the proportion of dilatation of the right ventricle and diastolic dysfunction. Tricuspid annulus anterior systolic excursion (TAPSE), pulmonary artery acceleration time (PAA), tricuspid regurgitation velocity (TRV), pulmonary artery systolic pressure (PASP), left ventricular longitudinal strain (LVGLS), of the left atrium (LAGLS) and the right ventricular free wall longitudinal strain (RVFWLS). Right ventricular dilation, right ventricular shortening fraction, TAPSE, PASP, TRV, LVGLS, LAGLS, and RVFWLS were associated with mortality. Conclusion Right ventricular dilation, right ventricular shortening fraction, TAPSE, PASP, TRV, LVGLS, LAGLS, and RVFWLS are the echocardiographic parameters that were associated with three-month mortality. FUNDunding Acknowledgement Type of funding sources: None. Table 2

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