Abstract
Introduction
Right ventricular failure (RVF) is recognized as a major cause of morbidity and mortality after left ventricular assist device (LVAD) implantation and identifying patients at risk remains a challenge. Given its structural complexity, it is not possible to fully assess the RV from one echocardiographic 2D plane and entire free wall visualization is more challenging in advanced heart failure patients with very severely dilated left ventricles. Our centre previously introduced a novel multi-plane approach whereby four different RV free wall segments (lateral, anterior, inferior and inferior coronal – figure 1) can be imaged from the same echocardiographic position using focused RV views and electronic plane rotation.
Purpose
The aim of the study was to determine the feasibility of using multi-plane echocardiography (MPE) to quantify right ventricular free wall longitudinal strain (RV-FWLS) in a small cohort of advanced heart failure patients prior to LVAD implantation.
Methods
Sixteen advanced heart failure patients underwent detailed RV assessment by MPE prior to LVAD implantation (median - 15 [6.3-29.8] days before). Feasibility and values of RV-FWLS were retrospectively assessed by an experienced sonographer on each of the 4 free wall segments using specialised RV strain analysis software. Feasibility was confirmed if all regions of the free wall were visualised and tracked appropriately throughout the cardiac cycle. Standard right heart 2D echo parameters and pre-implant right heart catheterisation (RHC) data were also collated.
Results
Mean RV-FWLS and feasibility in the four segments were as follows: lateral -12.4 ± 4.3% (81.3%); anterior -12.7 ± 6.1% (62.5%); inferior -11.8 ± 4.7% (75.0%); inferior coronal -11.6 ± 3.9% (43.8%). TAPSE values on the same segments were feasible in 100% of cases and mean values were as follows: lateral 15.1 ± 4.9mm; anterior 15.3 ± 4.7mm; inferior 13.4 ± 5.2mm; inferior coronal 11.4 ± 5.1mm. Mean pulmonary artery pressure (mPAP) measured by RHC was 27.2 ± 11mmHg. There was a slightly stronger negative correlation of RV-FWLS with increased mPAP in the lateral, anterior and inferior RV free wall segments compared to TAPSE (r²: -0.07-0.11 v -0.01-0.05).
Conclusion
There is reasonable feasibility for assessing RV-FWLS using MPE in 3 out of the 4 free wall segments and mean values were considerably lower than normal reference values. A stronger negative correlation with increasing mPAP suggests that RV dysfunction may be detected better by strain than by TAPSE measurement in pre-LVAD recipients. Larger, multi-centre studies are required to further assess these preliminary findings.
Abstract P931 Figure. Multi-plane RV imaging with strain
Right ventricular free wall strain in acutely decompensated heart failure patients with ischemic and non‐ischemic cardiomyopathy
