Three-Dimensional Echocardiography–Derived Right Ventricular Ejection Fraction Correlates with Success of Decannulation and Prognosis in Patients Stabilized by Venoarterial Extracorporeal Life Support - 02/02/18
Abstract |
Background |
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been proved to effectively rescue patients from refractory cardiogenic shock. The role of the right ventricle in VA-ECMO has been emphasized, but quantitative right ventricular (RV) analysis in this population has been lacking. Three-dimensional echocardiography (3DE) is currently suggested for RV volumetric analysis. The aims of this study were to assess 3DE-derived RV ejection fraction (RVEF) in patients with refractory cardiogenic shock stabilized by VA-ECMO and to explore the association between 3DE-derived RVEF and weaning success as well as the prognosis after the first intent of decannulation.
Methods |
Three-dimensional echocardiographic data sets before the first intent of decannulation were retrospectively selected and analyzed in 46 patients who underwent VA-ECMO for refractory acute circulatory collapse.
Results |
Twenty-eight of the 46 patients had protocol-defined success in weaning from VA-ECMO. In the success group, both ventricles were smaller and had better pumping function. By stepwise multivariate linear regression, RV free wall strain, left ventricular ejection fraction, RV fractional area change, and central venous pressure were found to be independently associated with RVEF. Receiver operating characteristic curve analysis showed that RVEF had the highest area under the curve (0.90, P < .001) for weaning success with a cutoff value of 24.6%. Worse RVEF (≤24.6%) was also associated with poor prognosis in terms of all-cause mortality within 30 days (hazard ratio, 15.86; 95% CI, 3.56–70.73; P < .001).
Conclusions |
Three-dimensional echocardiography–derived RVEF might represent the composite results of RV contractility, left ventricular performance, and fluid status. Under mechanical circulatory support of VA-ECMO, RVEF > 24.6% was associated with higher weaning success and lower 30-day mortality after the first intent of decannulation.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Three-dimensional echocardiography-derived RVEF is a feasible and reproducible parameter that can be used to evaluate patients with devastating cardiogenic shock. |
• | The authors offer a cutoff value of RVEF (24.6%) as a useful parameter in decision making for weaning from VA-ECMO. |
• | RVEF before decannulation of VA-ECMO correlated well with 30-day survival after disconnection from VA-ECMO. |
• | The noteworthy application of RVEF might reside in its nature of conveying information as the composite results of RV contractility, fluid status, and LV performance. |
Keywords : Extracorporeal membrane oxygenation, Right ventricular ejection fraction, Volumetric analysis
Abbreviations : 3D, 3DE, AUC, CVP, FAC, GLS, LV, LVEF, NRI, ROC, RV, RVEF, VA-ECMO
Plan
| Conflicts of Interest: None. |
Vol 31 - N° 2
P. 169-179 - février 2018 Retour au numéro
Article précédent
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