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.

中文翻译：

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三维超声心动图得出的右心室射血分数与经静脉动脉体外生命支持稳定的患者的成功脱皮和预后相关

背景

静脉动脉体外膜氧合（VA-ECMO）已被证明可以有效地使患者免于难治性心源性休克。右心室在VA-ECMO中的作用已得到强调，但该人群中缺乏右心室（RV）定量分析。目前，建议对三维超声心动图（3DE）进行RV容积分析。这项研究的目的是评估由VA-ECMO稳定的难治性心源性休克患者的3DE衍生的RV射血分数（RVEF），并探讨3DE衍生的RVEF与断奶成功之间的关联以及首次意图后的预后的时间。

方法

回顾性地选择了先行脱皮术之前的三维超声心动图数据集，并对46例因难治性急性循环衰竭而行VA-ECMO的患者进行了分析。

结果

在46名患者中，有28名在从VA-ECMO断奶中获得了协议定义的成功。在成功组中，两个心室都较小，并且具有较好的泵吸功能。通过逐步多元线性回归，发现RV游离壁应变，左心室射血分数，RV分数面积变化和中心静脉压与RVEF独立相关。受试者工作特征曲线分析表明，RVEF曲线下面积最大（0.90，P  <.001），代表断奶成功，截断值为24.6％。就30天之内的全因死亡率而言，更差的RVEF（≤24.6％）也与不良的预后相关（危险比，15.86； 95％CI，3.56-70.73；P  <.001）。

结论

三维超声心动图得出的RVEF可能代表RV收缩力，左心室表现和体液状态的综合结果。在VA-ECMO的机械循环支持下，RVEF> 24.6％与较高的断奶成功率和较低的30天死亡率降低相关。