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在左心室辅助器件接受者中,隐性右心室功能障碍和右心室血管脱

Paul J Scheel¹, Ilton M Cubero Salazar¹, Samuel Friedman²

¹Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

|November 30, 2023

概括

左心室辅助器械 (LVAD) 患者经常有未检测到的右心室 (RV) 功能障碍. 压力-体积循环显示RV收缩性和合性受损,表明LVAD后的隐形RV故障.

科学领域:

心脏病学心脏病学
心血管生理学心血管生理学
医疗器械医疗器械

背景情况:

在左心室辅助装置 (LVAD) 植入后检测右心力衰竭是临床上具有挑战性的.
右心室 (RV) 功能障碍可能发生在LVAD后,影响患者的结果.
压力-体积循环评估提供了一种敏感的方法来评估RV收缩性.

研究的目的:

为了比较LVAD患者的VR收缩性和后负荷,与使用压力-体积循环的参考试验对象相比.
研究RV收缩性,RV-肺动脉合和LVAD接受者的临床心力衰竭之间的关系.
确定潜在的非侵入性标志物,以评估LVAD患者的RV功能.

主要方法:

13名LVAD患者和20名非LVAD对照患者接受了侵入性血液动力学评估.
使用压力-体积循环来推导RV收缩性和后负载的末性弹性 (Ees) 和有效动脉弹性 (Ea).
分析了RV-肺动脉合 (Ees/Ea),RV隔膜张力和肺动脉脉动指数 (PAPi).

主要成果:

与对照组相比,LVAD患者的RV Ees和RV-肺动脉合 (Ees/Ea) 显著降低.
减少的RV Ees与LVAD和整体队列中减少的RV隔膜菌株相关.
低Ees/Ea的LVAD接受者表现出更高的临床心力衰竭率,与受损的RV Ees增大和增加的RV后负载 (Ea) 相关.
肺动脉脉动指数 (PAPi) 有效地确定了LVAD患者的低基线RV Ees/Ea.

结论:

在LVAD患者中,通常会出现隐藏的内在RV功能障碍.
接受LVAD的人可能缺乏RV收缩储备来管理增加的RV后负载,导致心室血管解.
在LVAD后减少RV收缩性可能与左心室卸载和随后的隔膜功能障碍有关.

关键词:

超声心脏学应变菌株左心室辅助装置的使用在压力-体积循环中,压力-体积循环肺高血压是一种肺高血压.右心力衰竭是什么意思

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