Cardiff Metropolitan University
Browse
Blood Flow kinetic energy is a novel marker f_Barry McDonnell.pdf (322.44 kB)

Blood flow kinetic energy is a novel marker for right ventricular global systolic function in patients with left ventricular assist device therapy

Download (322.44 kB)
journal contribution
posted on 2023-05-23, 12:58 authored by Koichi Akiyama, Paolo C. Colombo, Eric StohrEric Stohr, Ruiping Ji, Isaac Y. Wu, Keiichi Itatani, Shohei Miyazaki, Teruyasu Nishino, Naotoshi Nakamura, Yasufumi Nakajima, Barry McDonnell, Koji Takeda, Melana Yuzefpolskaya, Hiroo Takayama

 

Objectives: Right ventricular (RV) failure remains a major concern in heart failure (HF) patients undergoing left ventricular assist device (LVAD) implantation. We aimed to measure the kinetic energy of blood in the RV outflow tract (KE-RVOT) – a new marker of RV global systolic function. We also aimed to assess the relationship of KE-RVOT to other echocardiographic parameters in all subjects and assess the relationship of KE-RVOT to hemodynamic parameters of RV performance in HF patients.

Methods: Fifty-one subjects were prospectively enrolled into 4 groups (healthy controls, NYHA Class II, NYHA Class IV, LVAD patients) as follows: 11 healthy controls, 32 HF patients (8 NYHA Class II and 24 Class IV), and 8 patients with preexisting LVADs. The 24 Class IV HF patients included 21 pre-LVAD and 3 pre-transplant patients. Echocardiographic parameters of RV function (TAPSE, St', Et', IVA, MPI) and RV outflow color-Doppler images were recorded in all patients. Invasive hemodynamic parameters of RV function were collected in all Class IV HF patients. KE-RVOT was derived from color-Doppler imaging using a vector flow mapping proprietary software. Kruskal-Wallis test was performed for comparison of KE-RVOT in each group. Correlation between KE-RVOT and echocardiographic/hemodynamic parameters was assessed by linear regression analysis. Receiver operating characteristic curves for the ability of KE-RVOT to predict early phase RV failure were generated.

Results: KE-RVOT (median ± IQR) was higher in healthy controls (55.10 [39.70 to 76.43] mW/m) than in the Class II HF group (22.23 [15.41 to 35.58] mW/m, p < 0.005). KE-RVOT was further reduced in the Class IV HF group (9.02 [5.33 to 11.94] mW/m, p < 0.05). KE-RVOT was lower in the LVAD group (25.03 [9.88 to 38.98] mW/m) than the healthy controls group (p < 0.005). KE-RVOT had significant correlation with all echocardiographic parameters and no correlation with invasive hemodynamic parameters. RV failure occurred in 12 patients who underwent LVAD implantation in the Class IV HF group (1 patient was not eligible due to death immediately after the LVAD implantation). KE-RVOT cut-off value for prediction of RV failure was 9.15 mW/m (sensitivity: 0.67, specificity: 0.75, AUC: 0.66).

Conclusions: KE-RVOT, a novel noninvasive measure of RV function, strongly correlates with well-established echocardiographic markers of RV performance. KE-RVOT is the energy generated by RV wall contraction. Therefore, KE-RVOT may reflect global RV function. The utility of KE-RVOT in prediction of RV failure post LVAD implantation requires further study.

History

Published in

Frontiers in Cardiovascular Medicine

Publisher

Frontiers Media

Version

  • VoR (Version of Record)

Citation

Akiyama, K., Colombo, P.C., Stöhr, E.J., Ji, R., Wu, I.Y., Itatani, K., Miyazaki, S., Nishino, T., Nakamura, N., Nakajima, Y. and McDonnell, B.J. (2023) 'Blood flow kinetic energy is a novel marker for right ventricular global systolic function in patients with left ventricular assist device therapy', Frontiers in Cardiovascular Medicine, 10, p.862. doi: 10.3389/fcvm.2023.1093576

Electronic ISSN

2297-055X

Cardiff Met Affiliation

  • Cardiff School of Sport and Health Sciences

Cardiff Met Authors

Eric Stohr Barry McDonnell

Cardiff Met Research Centre/Group

  • Cardiovascular Physiology

Copyright Holder

  • © The Authors

Language

  • en

Usage metrics

    Cardiovascular Health & Ageing - Journal Articles

    Licence

    Exports

    RefWorks
    BibTeX
    Ref. manager
    Endnote
    DataCite
    NLM
    DC